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PRACTICE  '#  APPLIED  THERAPEUTICS 


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. .  O  S  T  E  O  !>  A  T  H  Y  . . 


BY- 


CHARLES  HAZZARD,  t»H.  B.  D.  O.. 


Professor   of  the    Practice   and   of  the    Principles 

of   Osteopathy. 


AMERICAX  SCHOOL  OF  OSTEOPATHY 


KIRKSVILLE,  MISSOURI. 


Copyright,  19OO. 

by 
Charles  Hazzard. 


\/ 


PART  I. 


GENERAL  METHODS. 


PREFACE. 


)  The  matter  contained  in  this  volume  was  delivered  as  a  course  of  lec- 

0  tures.     In  order  that  the  classes  might  have  lectures  in  printed  form  as  the 

1  work   progressed,  they  were    printed  and  distributed  in  weekl\'  lots,  but  in 
/>og        such  form  that  at  the  end  of  the  course  they  could  be  bound  and  preser\'ed. 

The  work  being  printed  piecemeal  in  this  wa}'  explains  why  there  occur 
various  blank  pages  through  the  book.  They  will,  however,  be  found  use- 
ful for  annotations. 

As  the  lectures  were  delivered  in  conjunction  with  daily  quizzes  in  the 
~^  symptomatolog)'  of  the  diseases  considered,  the  standard  texts  upon  Prac- 
tice of  Medicine  being  used,  it  was  manifestly  desirable  to  omit  from  this 
work  all  the  matter  so  easih'  accessible  in  those  writings.  This  plan  left 
the  author  free  to  devote  these  pages  entirely  to  osteopathic  considerations, 
intending  that  this  work  should  be  used  in  conjunction  with  any  standard 
text  of  medical  practice. 

No  special  attempt  has  been  made  to  follow  the  usual  classification  of 
diseases  closely,  for  various  reasons.  Likewise,  no  effort  has  been  made  to 
cover  every  disease  known.  It  is  hoped,  however,  that  the  effort  to  repre- 
sent the  osteopathic  view  of  disease  and  the  osteopathic  mode  of  treatment, 
even  upon  this  limited  scale,  may  not  have  been  in  vain. 

Charles  Hazzard. 

Kirksville,  Mo.,  Jan.  15,  1901. 


i 


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CHAPTER    I. 
Examination  of  the  Spine. 

Inspection,  percussion  and  palpation  are  the  methods  employed  by  the 
practitioner.  Of  these,  the  latter  is  used  almost  entirely.  Attention  must 
be  given  to  the  position  of  the  patient,  changing  it  as  required  for  the  best 
detection  of  the  various  lesions  for  which  examination  is  being  made.  For 
example,  lateral  deviations  of  vertebrae  and  departures  from  normal  curva- 
ture of  the  spine  are  best  detected  while  the  patient  is  sitting.  Points  of 
separation  between  spinous  processes,  thickening  of  posterior  spinal  liga- 
ments, rigidity  of  the  spine,  etc.,  are  most  readily  made  out  while  the 
patient  is  lying  upon  the  side. 

The  back  must  be  bared  in  examination.  For  ladies,  a  loose  ^own 
buttoned  down  the  front  and  back  may  be  convenientl)'  used. 

By  the  methods  mentioned  above  the  examiner  searches  for  certain 
definite  lesions,  as  follows: 

Inspection  reveals  the  color  of  the  skin;  rashes,  which  may  indicate 
disease;  the  presence  of  curvature;  unequal  muscular  development;  scars, 
strains,  and  excoriations  leading  to  inquiry  regarding  accident,  injury,  oper- 
ation or  the  use  of  poultice. 

Inspection  may  be  made  with  the  patient  sitting. 

Palpation  is  our  most  important  method  of  examination,  the  trained 
touch  revealing  to  the  Osteopath  most  of  the  lesions  which  he  regards  as 
the  causes  of  disease. 

With  the  patient  sitting  slightl)-  bent  forward,  the  arms  folded  loosely 
or  the  hands  resting  lightly  on  the  knees,  the  examiner  stands  behind  the 
patient  and  passes  his  two  index  fingers,  or  the  index  and  second  fingers  of 
the  examining  hand,  carefully  down  the  opposite  sides  of  the  vertebral 
spines,  he  notes: 

I.  Single  vertebrae  or  groups  of  vertebrae  which  may  be  deviated  later- 
ally from  normal  position.  In  such  case  there  is  usuall}-.  though  not  always, 
tenderness  in  the  tissues  upon  the  side  of  deviation,  owing  to  the  irritation 
by  the  process. 

II.  Lateral  swerving  or  sagging  of  an)-  portion  of  the  spine. 

III.  Any  exaggeration,  deviation  from  or  lessening  of  the  normal  curves 
of  the  spine.  The  most  common  of  these  are  a  flattening  of  the  spine  anter- 
iorly at  the  dorsal  curve  between  the  shoulders, a  flattening  of  the  spine  pos- 
teriorly at  the  lumbar  curve,  these  two  lesions  together  causing  the  so 
called  "straight  spine." 

IV.  Sharp  friction,  made  by  passing  the  hand  quickly  down  the  spine, 
reddens  the  tips  of  the  spinous  processes  so  that  one  may  then  count  them 
or  note  their  alignment. 


6  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

y.  The  flat  of  the  hand  is  passed  down  over  the  posterior  aspect  of 
the  sacrum  and  detects  any  flattening  or  bulging  thereof.  It  is  also  passed 
over  the  posterior  superior  iliac  spines,  noting  their  degree  of  prominence 
and  comparing  them  with  each  other  relatively  to  the  sacrum. 

VI.  The  cushions  of  the  examining  fingers  are  pressed  deepl)-  into  the 
sacro-iliac  spaces  to  detect  any  abnormal  tension  in  the  superficial  or  deep 
tissues. 

\TI.  The  index  finger  follows  the  course  of  the  coccyx  to  its  tip,  noting 
any  lateral,  anterior,  or  posterior  deviation. 

\TII.  The  inde.x  finger  is  carefully  passed  down  the  spine  upon  the 
spinous  processes,  pressure  being  made  firml)'  upon  each,  to  detect  either 
anterior  or  postcyior projection  of  vertebra;. 

IX.  The  tctnpcrature  of  the  back  is  found  h\  passing  the  palm  of  the 
hand  evenly  over  it.  Vaso-motor  disturbances,  resulting  in  lowered  or  in- 
creased temperatures  of  certain  areas,  may  be  thus  discovered.  Frequently 
a  cold  area  may  be  traced  diagonally  backward  and  upward  along  the  course 
of  the  spinal  nerves  toward  the  seat  of  some  lesion 

The  patient  is  now  placed  upon  his  side  in  an  easy  position,  the  ex- 
aminer stands  at  the  front  of  the  patient,  and  passing  his  hands  over  to  the 
spine,  continues  the  examination. 

X.  The  cushion  of  the  examining  finger,  which  is  held  at  rigiit  angles 
to  the  spinal  column,  is  carefull)-  pressed  deeply  into  the  space  between 
each  successive  pair  of  spinous  processes.  It  discovers  an\  sepataiion  or 
approximation  of  processes,  thus  of  vertebrae. 

Points  of  anatomical  weakness  are  frequentl)'  found  at  the  junction  of 
the  ticclfth  dorsat  with  the  first  lumbar  vertebra,  also  at  the  junction  of  the 
fifth  luryibar  \\\\.\\  the  sacrum. 

The  fifth  lumbar  is  often  prominent  posteriori)-,  but  is  also  very  apt  to 
be  luxated  anteriorlw 

XI.  The  examining  hand  is  passed  slowly  along  the  spinal  column  to 
note  an}-  general  or  local  thickening  and  increased  tension  in  the  posterior 
spinal  ligaments  which  results  is  partially  obliterating  the  space  between 
the  spinous  processes,  and  in  producing  the  so-called  "5W(7t?//^.f/!>/;^a/ r^j/z^wM." 

XII.  The  examining  fingers  are  pressed  firmly  into  the  spinal  muscles 
and  moved  transerversely  to  the  course  of  their  fibres  for  the  purpose  of 
detecting  an)'  z}qx\oxvc\2\  hardening  or  coyitracticring  of  them.  Contractures 
generally  affect  certain  sets  of  fibres  rather  than  the  muscle  as  a  whole. 
The)'  may  be  situated  in  the  superficial  or  in  the  deep  muscles,  and  ma)'  be 
priynary  or  secondary  according  as  they  are  produced  b)'  direct  or  indirect 
lesion  of  the  fibres. 

Xlil.  The  body  of  the  patient  is  braced  against  that  of  the  practitioner, 
who  places  the  fingers  of  both  hands  upon  the  under  side  of  the  row  of 
spinous  processes,  (the  patient   lying  on    his    side)    and    draws    the    spine 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  7 

fo«"cibly  toward  him,  noticing  whether  the  spine  be  rigid,  or  too  greatly    ;'<?- 
laxed. 

It  must  be  borne  in  mind  that  bony  lesions  are  not  alone  important. 
Ligamentous  iesions  are  quite  as  much  so,  and  though  they  are  not  so  gen- 
erally discernible  as  are  the  former,  the  student  must  not  forget  that  follow- 
ing upon  and  consequent  to  bony  lesion  they  may  bring  pressure  upon 
important  structures,  may  thus  interfere  with  the  functions  of  blood-vessels, 
nerves,  etc.,  and  become  a  fruitful  source  of  ill.. 

Percussion,  Pressure  and  Motion  may  be  emplo)'ed  in  the  examina- 
tion of  the  spine,  and  may  sometimes  reveal  deep  tenderness  or  pain  in  the 
tissues  which  has  escaped  notice  by  the  other  methods. 

Upon  motion,  certain  sounds  are  heard  in  various  parts  of  the  column, 
due  to  the  motion  of  parts  upon  each  other.  These  seem  to  occur  most  fre- 
quently in  the  neck,  between  the  articular  processes,  and  in  the  lumbar 
region,  between  the  bodies  of  the  vertebrae  They  may  occur  anywhere 
along  the  spine  and  are  of  diagnostic  value  in  indicating  relaxation  of  liga- 
ments, interference  with  blood -supply,  resulting  in  insufficient  secretion  of 
synovial  fiuid,  or  malposition  of  bony  parts. 


CHAFTKR  II 
Treatment  of  the  Sfmne. 

In  lliis  chapter  it  is  proposed  to  outline  the  general  method  of  pro- 
cedure in  spinal  treatment  As  no  specific  case  or  disease  is  now  under 
consideration,  the  student  must  bear  in  mind  that  the  treatments  described 
are  general  methods  of  work  and  that,  in  any  given  case,  he  would  find  it 
necessary  to  select  and  combine  these  different  modes  in  a  manner  best 
calculated  to  enable  him  individually  to  reach  the  case. 

As  far  as  practicable  the  specific  lesions  nu-ntioned  in  chapter  I  will 
be  considered,  and   treatments  appropriate  to  their  reduction  will  be  given. 

These  treatments  are  all  manipulative.  They  have  as  their  object  the 
righting  of  what  is  mechanically  wrong  They  are  therefore  mechanical  of 
necessity,  and  are  founded  upon  the  necessities  of  the  human  mechanism 
when  deranged. 

In  treatment,  the  practitioner  may  have  in  view  either  or  both  of  two 
objects.  He  works  to  right  the  spine  itself,  and  to  affect  it  alone,  or  he 
works  upon  the  spine  to  affect  some  other  part  of  the  body  pathologically 
connected  with  the  part  of  the  spine  in  question. 

I.  The  patient  lies  upon  the  ventral  aspect  oi  the  body  in  as  comfort- 
able a  position  as  possible.  The  head  turns  easily  to  one  side,  and  the  arms 
hang  down  loosely  at  the  sides  of  the  table.  The  practitioner  must  see  that 
the  patient  thoroughly'  relaxes  the  muscles  of  the  whole  body.  He  now, 
standing  at  the  side  of  the  patient,  uses  the  palms  of  the  hands  or  the 
cushions  of  the  fingers  to  thoroughly  manipulate  and  relax  all  the  spinal 
muscles.  In  treating  the  muscles  upon  the  side  toward  him,  he  works  from 
one  end  of  the  spinal  column  to  the  other,  in  a  direction  at  right  angles  to 
the  general  direction  of  the  muscular  fibres.  He  treats  the  muscles  of  the 
opposite  side  by  spreading  them  away  from  the  spinous  processes. 

In  this  wa)'  all  contraiturs  of  the  muscles  are  released, yfa^^'  muscles  are 
toned,  <^/i?i7rf  ««(/ wrrzr  mechanisms  are  freed  and  upbuilt.  Thus  removing 
of  contractures  is  sometimes  a  necessary  preliminary  step  to  the  diagnosis 
of  deeper  lesions  which  ma)-  have  been  masked  b\-  them 

II.  The  patient  lies  upon  his  side,  the  practitioner  stands  a^  the  side 
of  the  table,  in  front  of  the  patient,  with  one  hand  he  grasps  the  upper- 
most arm  of  the  patient  just  above  the  elbow;  with  the  other  hand  he  holds 
under  the  spinous  processes  of  any  portion  of  the  spine  under  treatment. 
Now,  using  the  arm  as  alevet,  he  pushes  it  downward  and  forward,  at  the 
same  time  springing  the  spine  toward  him. 

This  treatment  releases  tension  in  all  deep  structures,  restores  free-play 
between  bony  parts,  and  removes  pressure  from  blood-vessels  and  nerves. 
It  may  be  applied  in  all  cases  of  curvature^  sagging  or  swerving  of  a  portion 


PRACTICE  AXD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  Q 

oi  the  spine, /aferal  dez'iafwns  of  vertebrae,  in    separating    or    approximating 
vertebrae,  etc. 

III.  Practicall)'  the  same  effect  may  be  obtained  upon  the  lower  por- 
tion of  the  spine  as  follows;  with  the  patient  still  upon  the  side,  his  thighs 
and  legs  are  flexed,  and  fixed  by  pressure  of  the  abdomen  of  the  practitioner 
against  them.  Both  hands  are  now  free  and  spring  the  spine  strongly  up- 
ward toward  him,  or  manipulate  the  muscles;  or 

IV.  With  the  patient  still  l>'ing  upon  his  side,  the  practitioner  leans 
over  him,  placing  his  forearms,  one  against  the  iliac  crest  and  the  other 
against  the  shoulder.  He  now  with  his  forearms  pushes  these  two  points 
further  apart,  while  with  both  hands  he  springs  the  middle  portions  of  the 
spine  toward  him,  or  manipulates  the  muscles. 

It  will  be  observed  that  the  treatments  described  under  II,  III  and  IV 
above  all  may  be  used  to  thoroughly  stretch  any  portion  of  the  spine  by 
laterally  directed  force.  In  this  way  deeper  stretching  of  all  spinal  struc- 
tures may  be  accomplished  within  the  limits  of  safety  than  b)'  stretching 
the  spine  as  a  whole  by  longetiidinal  traction. 

V.  The  latter  is  applied  with  the  patient  lying  upon  his  hack;  the 
practitioner,  standing  at  the  head  of  the  table,  passes  one  hand  beneath  the 
occiput,  the  other  beneath  the  chin,  and  draws  toward  him.  The  required 
degree  of  resistance  is  offorded  by  the  weight  of  the  patient  or  by  an  as- 
sistant holding  the  ankles. 

The  neck  must  not  be  rotated  during  this  forcible  tension,  and  jerking 
must  be  a\oided. 

VI.  The  principle  of  exaggeration  of  the  lesioii  is  one  that  ma)'  be  ap- 
plied to  the  treatment  of  man\'  bony  luxations.  It  consists  in  so  manipulat- 
ing the  parts  as  to  tend  to  further  increase  their  malposition,  and  in  then 
applying  pressure  to  them  in  such  a  direction  as  to  force  them  back  toward 
normal  position  at  the  same  time  as  the  part  in  question  is  released  from  its 
condition  of  exaggeration. 

This  motion  releases  tension,  loosens  adhesion,  and  gains  the  benefit 
of  the  natural  recoil  of  the  structures  from  their  exaggerated  position. 

VII.  With  the  patient  prone  and  the  practitioner  kneeling  tipon  the 
table  at  one  side  of  the  patient,  or  with  a  knee  upon  either  side,  direct  pres- 
sure ma\'  be  applied,  from  above  downward,  to  all  spinal  parts.  This  posi- 
tion of  relaxation  is  favorable  for  forcing  vertebrae  or  the, heads  of  ribs  in- 
to place  and  for  the  stretching  of  the  deep  and  anterior  spinal  ligaments. 

VIII.  The  patient  lies  across  the  table  with  the  abdomen  and  anterior 
chest  resting  upon  it,  the  arms  and  head  hanging  loosely  down  upon  one 
side  and  the  legs  upon  the  other.  The  practitioner  may  stand  at  either 
side  of  the  table  (or  kneel  upon  it,)  and  work  for  results  as  in  VII,  with  the 
additional  advantage  that  the  arms,  neck,  or  limbs  ma)'  be  manipulated  at 
will  in  the  course  of  the  treatment. 

IX.  The    patient    sits,  the  practitioner  stands  in  front,  slightl)^  to  one 


10  fKACTICE  AM)  AFPLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

side.  He  passes  the  arm  nearest  the  patient  back  ot  the  neck,  and  slips  his 
hand  under  the  0|)posile  axilla.  This  bends  the  neck  and  upper  spine  for- 
ward and  swings  the  opposite  side  of  the  thorax  backward,  thus  rotating  the 
spine.  By  using  the  free  hand  as  a  fixed  point  at  various  points  along  the 
spine,  its  successive  portions  may  be  thoroughly  rotated  and  all  of  its 
structures  loosened. 

X.  The  patient  sits;  the  ^)ractitioner  stands  behind,  pushing  the  head 
forward  and  to  one  side  with  one  hand,  while  with  the  other  he  makes  fixed 
points  along  the  upper  spine,  upon  the  side  from  which  the  head  has  been 
forced.  The  head  is  now  swung  forward  and  to  the  side  opposite  its  first 
position  while  the  hand  brings  pressure  upon  the  fixed  points,  one  after  the 
other.  This  motion  makes  us<t  oi  the  neck  as  a  lever  of  the  first  class,  the 
fulcrum  being  formed  b)'  the  hand  at  the  fixed  point,  with  the  lesion  (weight) 
below,  and  the  power  (hand  applied  to  the  head)  above.  It  is  a  method  of 
"exaggeration  the  lesion,"  and  is  especiail)'  useful  for  the  reduction  of 
lateral  luxations  in  the  upper  part  of  the  spine. 

XI.  Th"  patient  sits  and  ciasps  his  hands  around  his  ncck\  the  practi- 
tioner stands  behind,  passes  his  arms  beneath  the  axillae  and  his  palms  be- 
hind the  patient's  wrists,  which  he  grasps  in  his  hands.  He  now  places  one 
foot  upon  the  stool  and  presses  the  flat  of  the  knee  against  the  back  at  one 
side  of  the  spinous  processes.  As  the  practitioner  straightens  his  body  and 
draws  the  patient  back  against  his  knee  the  neck  and  upper  dorsal  spine 
are  bent  forward,  the  middle  and  lower  portions  of  the  spine  are  pressed 
forward  by  the  knee,  the  r:capulae  travel  back  and  up,  and  all  of  the  ribs, 
except  the  first  three  or  four  pairs  which  are  sprung  forward  and  downward, 
are  drawn  strongly  backward  and  upward. 

This  treatment  thoroughly  stretches  most  of  the  spinal  ligaments, 
costo-spinal  ligaments,  muscles  of  the  back  of  the  neck,  scapulae,  and  of  the 
spine.  It  also  brings  tension  upon  most  of  the  intervertebral,  the  costo- 
vertebral, the  costo-sternal,  acromio  chiricular  and  claviculo  sternal  articu- 
lations. 

XII.  With  the  patient  sitting,  the  practitioner,  standing  behind,  may 
place  one  icnce  beneath  the  patient'' s  axilla,  thus  raising  and  fixing  the  shoulder 
and  the  ribs  of  one  side  of  the  thorax.  This  relieves  the  spine  of  the 
weight  of  these  structures  and  affords  the  practitioner  two  free  hands  with 
which  he  ma\'  manipulate  the  spine  or  opposite  side  of  the  thorax,  using 
the  neck  and  other  arm  of  the  patient  as  levers,  if  desired. 

XIII.  The  ligaments  of  the  posterior  lumbar  and  of  the  sacro  iliac  regions 
may  be  thoroughly  relaxed  b>'  bending  the  bod\'  of  the  patient,  who  is  sit- 
ting far  forward  between  his  well  separated  knees.  • 

XIV.  The  same  object  is  accomplished  with  the  patient  '^tfhc,  while 
the  legs  and  thighs  are  both  forcibly  flexed  to  their  limit. 

XV.  To  stretch  the  posterior  scapular,  rhomboid,  and  levator  an^uli  scap- 
ulae muscles,  the  patient  lies  upon  his  back,  while  the  practitioner  slips  one 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  II 

hand  beneath  the  shoulder  and  grasps  the  spinal  edge  of  the  scapula,  which 
has  been  approximated  as  closely  as  possible  to  the  spinal  column.  The 
other  hand  holds  the  arm  of  the  patient  just  above  the  elbow,  and  the  arm 
is  raised  and  pushes  across  the  che.st,  the  patient's  hand  being  in  this  way 
forced  across  well  into  to  the  opposite  axilla. 

XVI.  With  the  same  position  of  the  patient,  the  anterior  scapular  mus- 
cles may  be  reached  by  thrusting  the  fingers  of  one  hand  deeply  beneath  the 
spinal  edge  of  the  scapula,  while  the  other  hand  grasps  the  point  of  the 
shoulder.  Now  the  whole  lateral  half  of  the  shoulder-girdle  may  be  rotated, 
the  first  hand  continually  working  deeper  beneath  the  scapula. 

XXII.  A  thorough  ^'breaking  up"  of  the  lower  dorsal  and  lumbar 
regions  of  the  spine  is  accomplished  as  follows:  The  patient  lies  prone; 
the  practitioner  stands  at  the  side  and  passes  one  arm  beneath  the  thighs  of 
the  patient,  just  above  the  knees  which  he  raises  just  free  of  the  table 
moving  them  horizontally  from  side  to  side.  At  the  same  time  his  free 
hand  is  applied  to  the  part  of  the  spine  in  question,  the  thumb  upon  one 
side  of  the  spinous  processes,  the  fingers  upon  the  other.  The  thumb  and 
fingers  make  lateral  pressure  upon  the  spine,  alternating  with,  and  in  a  con- 
trary direction  to,  the  movement  of  the  limbs. 

This  treatment  loosens  and  separates  the  vertebr^t,  releases  tension  of 
muscles  and  ligaments,  and  upbuilds  nerve  and  blood  action. 

Very  many  more  treatments  might  be  described,  but  enough  o-eneral 
treatments  have  been  given  to  reach  all  parts  of  the  spine  and  to  correct 
the  lesions  that  are  likel\-  to  be  met  with  in  practice.  These  treatments 
may  be  combined,  or  ma)'  be  taken  for  the  basis  of  new  ones  which  the 
practitioner  ma}'  often  find  necessary  to  work  out  in  order  to  reach  some 
special  lesion  or  to  treat  some  special  case. 

In  this  portion  of  the  text,  the  treatments  can  of  necessity  be  described 
and  their  application  be  given,  onl)-  in  a  general  wa)-.     They  are  outlines  of 
methods  of  procedure,  and   the  application   of  the   principles  embodied  in 
them  must  be  made  to  the  specific  lesion  met   with   in  a  given   case  by  the 
practitioner. 

The  lesions  described  in  Chapter  I,  such  as  lateral  deviation  of  a  \er- 
tebra  or  lateral  swerving  of  a  portion  of  the  column;  vertebrae  separated  or 
approximated;  anterior  or  posterior  luxations  of  vertebr^t;  the  "smooth 
spine";  the  loss  of  normal  curvature;  the  rigid  or  relaxed  spine,  etc.,  may 
all  be  reduced  b)'  various  applications  of  these  treatments. 

Generally  speaking,  the  results  attained  by  the  use  of  these  treatments 
are,  the  relaxation  of  contractured  muscles;  the  release  of  tension  in  nerve 
muscle,  ligament  or  other  fibrous  structure;  the  reduction  of  bon\-  lesion- 
the  removal  of  obstruction  from,  and  the  renewal  of,  blood  and  nerve  cur- 
rents. 

XVIII.  Thejiflh  lumbar  vertebra,  after  luxation,  ma)'  be  restored  in 
various  ways.     'Y\\q.  posterior  displacement  xs  \.\i&  most  frequent.     In  this   case 


\2  PRACTICE  AND  APPLIED  THERAPEUTICS  OE  OSTEOPATHY. 

one  ma\-  place  the  patient  upon  his  side,  flex  the  knees  against  the  abdo- 
men, fix  the  fifth  hinibar  b>'  holding  beneath  it  with  one  hand,  while  with 
the  other  beneath  the  thighs  the  weight  of  the  body  is  rotated  about  the 
fixed  point.  Recent  dislocations  maybe  adjusted  in  this  way  without  dif- 
ficulty. In  long  standing  cases  continued  treatment  is  necessar\',  the  work 
of  relaxation  of  parts  etc..  in  preparation  for  its  reduction,  being  performed 
in  part  by  the  application  of  principles  already  described. 

With  the  patient  upon  his  back  and  the  body  below  the  fifth  lumbar 
protruding  over  the  foot  of  the  table,  the  practitioner  standing  between  the 
limbs  and  holding  one  under  each  arm,  places  both  hands  beneath  the  pel- 
vis, makes  a  fixed  joint  at  the  fifth  lumbar,  and  by  the  movement  of  his  own 
body,  rotates  the  lower  part  of  the  patient's  body  about  the  fixed  point. 

With  the  patient  upon  his  back,  the  practitioner  standing  at  one  side, 
the  clenched  hand  is  placed  beneaih  the  bod\-  at  one  side  of  the  fifth  lum- 
bar spine.  The  leg  and  thigh  are  now  strongly  flexed  b\'  the  free  hand, 
external  circumduction  of  the  thigh  is  made,  and  the  weight  of  the  body  is 
thrown  onto  the  fixed  joint.  In  some  cases  this  treatment  is  sufficient  for 
replacing  the  bone. 

In  case  the  vertebra  be  anterior  the  above  treatments  may  be  applied  to 
the  case  for  the  purpose  loosening  all  the  ligaments. 

Also  the  principle  of  exaggerating  the  lesion  may  be  applied  by  mak- 
ing a  fixed  point  of  the  practitioner's  knee  \X.  the  fifth  lumbar,  the  pati  nt 
sitting.  The  patient's  body  is  bent  backward  against  the  fixed  po'nt  and 
then  rotated  forward.  Also,  with  the  patient  sitting  and  the  fifth  lumbar 
fixed  with  one  hand,  the  free  arm  grasps  the  body  of  the  patient  and  ro- 
tates it  about  the  fixed  point.  The  bodies  of  the  vertebra  may  be  thus 
warped  or  slightly  moved  upon  each  other,  drawing  the  bone  back  to  place. 

Jn  man)-  long  standing  cases  of  bony  lesion,  the  strengthening  of  the 
surrounding  muscles  and  ligaments  must  take  place  and  be  depended  upon 
to  hold  the  ground  gained  as  the  part  is  gradually,  during  a  course  of 
treajjTTent,  brought  back  towards  its  normal  position. 

XIX.  In  case  the  sacnim  be  found  to  be  anterior  or  posterior  from  its 
normal  position,  this  is  a  matter  partl\'  relative  to  the  position  of  the  in- 
nominate bones,  luxations  of  which  will  be  discussed  later. 

In  cases  of  posterior  protrusion,  after  relaxation  of  the  sacro-iliac  lig- 
aments, pressure  may  be  made  with  the  keee  directly  upon  the  sacrum  from 
behind,  with  the  patient  either  sitting  or  Ixingupon  his  side.  At  the  same 
time  the  pelvis  and  the  upper  parts  of  the  body  are  drawn  strongly  back- 
wards. 

XX.  In  restoring  the  coccyx  to  normal  position  both  external  and  rec- 
tal treatment  may  be  necessary.  In  some  cases  external  treatment  alone 
will  be  sufficient.  The  sacro-cocc\geal  articulation  is  generallj-  quite  pli- 
able. In  ^A7fr«rt/ treatment  attention  must  be  first  given  to  the  relaxation 
of  the    muscles  and    fibrous    tissues    concerned.     The   bone    may   then    be 


PRACTICE  AND  AI^FMED  THERAPEUTICS  OF  OSTEOPATHY.  I  3 

grasped  and  moved  or  sprung  from  either  side  toward  the  median  line,  may 
be  forced  anteriorl}-,  or  the  finger  may  be  gently  inserted  beneath  its  tip 
and  may  draw  it  back  toward  its  natural  position. 

J^eda/  ^reahnefii  should  not  be  ^iven  ohener  than  once  a  week  or  ten 
da)S.  The  patient  lies  upon  his  side  or  bends  over  a  table.  The  index 
finger,  anointed  with  vaseline  or  other  oil  is  inserted,  palm  down,  into  the 
rectum.  It  is  then  turned  palm  up,  laid  along  the  hollow  of  the  coccyx, 
and  swept  from  side  to  side,  to  free  the  action  of  blood-vessels  and  nerves. 
With  the  finger  in  the  rectum  and  the  thumb  outside,  the  bone  may  be 
grasped  and  moved  toward  any  position  necessary.  As  a  rule  its  restora- 
tion to  a  normal  position  is  only  gradually  accomplished. 


CHAPTER  III. 
Examination  of  the  Neck. 

Inspection  and  palpation  are  the  two  phy.sical  methods  used  in  exam- 
ination of  the  neck. 

Inspection  reveals  scars  due  to  wounds,  and  suggests  a  history  of  acci- 
dent or  operation.     The  general  conformation  of  the  neck  should  be  noted. 

Upon  the  anie; tor  aspeci  may  he  seen  enlargement  due  to  increase  in 
the  size  of  the  tonsils  or  of  the  lymphatic  glands;  abnormal  pulsations  or 
engorgement  of  the  blood-vessels;  an  enlarged  thyroid  gland. 

Upon  \.\),e posterior  aspect  may  be  found  enlargement  of  the  muscles  or 
thickening  of  the  tissues.  Frequently  an  inequality  of  the  tissues  in  and 
below  the  sub-occipital  fossse,  due  to  thickening  or  to  bony  lesion, 
occurs. 

Any  unnatural  position  in  which  the  head  may  be  held  should  be  noted. 

Palpation  is  here,  as  elsewhere,  the  important  method  of  examination. 
For  convenience  the  anterior  structures  may  be  examined  first.  The  patient 
lies  prone,  relaxing  the  neck  as  much  .is  possible.  This  object  may  be 
aided  by  the  practitioner,  placing  one  hand  upon  the  forehead  and  gently 
rolling  the  head  from  side  to  side,  while  with  the  other  he  lightly  manipu- 
lates the  muscles  of  the  neck. 

A.  Anterior  Structures. 

I.  The  tonsils  are  located  by  pressure  of  the  fingers  just  below  the 
angles  of  the  inferior  maxillary  bone.  Any  enlargement  or  tenderness  of 
the  organ  is  to  be  noted. 

II.  Tender  points,  frequent  in  catarrhal  conditions,  are  found  by  deep 
pressure  behind  the  angles  of  inferior  maxillary. 

III.  The  hyoid  bone  is  located  by  pressing  all  the  soft  tissues  just  below 
the  jaw  toward  the  median  plane  of  the  body.  This  causes  a  prominence 
of  the  greater  cornu  upon  the  opposite  side  of  the  throat,  which  may  be 
easily  detected  by  the  index  finger. 

The  finger  remains  upon  the  cornu  and  pushes  it  back  toward  the  op- 
posite side,  thus  making  prominent  the  greater  cornu  of  that  side.  With 
the  index  finger  and  thumb  upon  the  cornua,  it  may  be  moved  about  and  a 
diagnosis  of  its  position  be  made. 

IV.  The  hyoid  muscles,  superior  and  inferior,  are  now  carefully  palpated 
to  discover  contracture,  hypertrophy,  congestion  or  tenderness  in  them.  In 
public  speakers,  singers,  and  others  liable  to  throat  disease  the  superior 
hyoid  muscles  are  often  in  pathological  condition. 

V.  From  the  hyoid  region  palpation  is  carried  down  over  the  thyroid 
and  cricoid  cartilages,  noting    whether   their  condition  be  normal,  and  is  ex- 


I<,  IKACTICK  AND  AfPIIKO  THEKAPEUTICS  OF  OSTEOFATHV. 

teiuicd  alops  the  shoulder  to  the  root  of  the  neck.  In  this  examination  the 
parts  are  graspecl  between  the  thumb  and  fingers  of  the  examining  hand 
and  are  moved  from  side  to  side.  At  the  same  time  deep  but  gentle  pres- 
sure is  made  at  either  side  of  the  lar\nx  and  trachea  in  order  to  note  any- 
undue  U-tidinit'ss  in  the  Ian  ngcal  nerves 'a^  generally  revealed  by  an  impulse 
upon  the  part  of  the  patient  to  cough  or  swallow,  inunobility  ox  harshness  of 
sound  \.\\iOv\  motion  of  these  parts  as  above  abnormal  tension  in  the  related 
muscles  and  other  tissues. 

\1.  Enlargement  or  wasting  of  the  thyroid trland  ox  enlargement  of  the 
drvical  Ixmphatii  glands  must  be  noted. 

\'1I.  '\\\c  stertio  mastoid  xx\\\%c\c  is  made  prominent  by  causing  the 
patient  to  turn  his  head  to  the  opposite  side  Pressure  deep  behind  the 
anterior  border  of  this  muscle  impinges  upon  \.\\*t  pneumogasttic  nerve.  Ten- 
derness in  it  upon  pressure  ma)-  accompany  liver  or  stomach  disease. 

\'11I.  The />///vf;/7f  w^TZ'^  arises  from  the  third,  fourth,  and  fifth  cervical 
nerves,  and  may,  at  its  points  of  origin,  be  pressed  backward  against  the 
bony  column.  It  may  be  reached  also  by  deep  pressure  with  the  thumb  or 
finger  in  the  angle  formed  by  the  posterior  edge  of  the  sterno-mastoid  mus- 
cle with  the  upper  margin  of  the  clavicle.  This  pressure  must  be  directed 
from  above  diagonall\-  downward  and  forward  toward  the  sternum. 

I X .  Press  H  re  of  th  e  h  ea  d  direct  I;} '  doTi'nTvard  upon  the  spinal  column  with 
rotation,  will  sometimes  discover  deep  pain  at  points  of  lesion. 

X.  The  posterior  structures  of  the  neck  may  be  tested  for  abnormal 
tension  by  flexing  the  head  upon  the  thorax,  the  patient  prone. 

XI.  The  palms  of  tne  hands  may  be  passed  evenly  over  the  surface  of 
the  neck  to  examine  for  variations  of  temperature.  Hot  or  cold  areas  may 
be  found.  It  is  common  to  find  an  area  of  increased  temperature  at  the 
base  of  the  skull  behind. 

H.    rOSTEKIOK  AND   LaTERAI    StRUCTUKES. 

I.  With  the  patient  sitting,  the  practitioner  passes  the  examining  hand 
down  along  the  back  of  the  neck.  Just  below  the  occiput  is  a  depression 
in  which  he  ma)'  feel  the  upper  end  of  Xh^  ligament \)n  niichae  and  the  inner 
borders  of  the  trapezius  muscles.  With  the  head  bent  slightl)'  forward  and 
the  examining  fingers  pressed  deeply-  into  this  space  abnormal  tension  of 
these  structures  ma)'  be  noted. 

JI.  The  second eer-cical  spine  is  the  first  bony  prominence  felt  below  the 
occiput.  The  spines  of  the  third,  fourth  and  fifth  are  made  out  with  diffi- 
culty, as  they  recede  from  the  surface  anteriorl)'.  The  next  prominent 
spine  is  that  of  the  sixth,  the  next  of  the  seventh.  The  latter  is  prominent, 
but  not  so  much  so  as  the  first  dorsal,  from  which  it  must  be  carefully  dis- 
tinguished. 

Anterior,  posterior,  or  lateral  deviations  oi  the  cervical  vertebrae  ma)-  be 
diagnosed  by  this  examination  of  the  spinous  processes. 


PRACTICE  AND  APPLIED  TH  ERAPFX'TICS  OF  OSTEOPATHY.  I7 

III.  Anterior  dislocations  of  the  upper  three  cervical  vertebrae  may 
be  sometimes  noted  b)-  examining  for  the  prominence  caused  by  the  body 
upon  the  posterior  wall  of  the  pharynx.  This  is  done  by  passing  the  finger 
over  these  bodies. 

IV.  The  position  of  the  atlas  is  examined  as  follows:  The  patient 
lies  upon  his  back  and  the  practitioner  stands  at  the  head  of  the  table.  The 
transverse  processes  are  located  by  thrusting  the  palms  of  the  examining 
fingers  deeply  into  the  space  between  the  angle  of  the  inferior  maxillary 
bone  and  the  tip  of  the  mastoid  process.  A  finger  is  placed  upon  each 
transverse  process  which  is  usually  prominent.  Normally  these  processes 
should  be  midway  between  the  angle  of  the  jaw  and  the  tip  of  the  mastoid 
process.  If  they  are  too  far  forward,  too  far  backward,  to  one  side,  or  if 
one  be  forward  and  the  other  backward,  the  diagnosis  is  readily  made  by 
comparison  of  the  position  of  the  processes  relatively  to  the  points  men- 
tioned, and  the  corresponding  displacement  of  the  atlas  is  discovered. 

V.  Lateral  deviations  of  vertebrae  in  the  neck  are  best  found  by  ex- 
amining the  articular  processes. 

The  head,  with  the  patient  lying  upon  his  back,  is  turned  to  one  side, 
making  prominent  the  row  of  articular  processes  upon  the  opposite  side. 
The  second  cervical  spine  is  now  readily  located  by  its  prominence  behind, 
and  the  finger  traces  from  it  around  to  the  articular  processes  of  the  second,  lying 
at  about  the  same  level,  but  slightly  above.  A  finger  is  held  upon  this  pro- 
cess and  the  head  is  turned  to  the  opposite  side.  The  other  articular  pro- 
cess of  the  second  is  then  located  in  the  same  way.  They  are  now  com- 
pared while  moving  the  head  slightly  from  side  to  side,  and  lateral  devi- 
ations or  tenderness  in  the  tissues  are  easily  made  out.  With  these  two 
points  fixed,  the  head  may  be  gently  turned  from  side  to  side,  and  the  ex- 
amining fingers  travel  down  over  the  successive  articular  processes,  careful 
examination  being  made  of  the  position  of  each. 

VI.  Deep  pressure  may  be  made  from  the  anterior  surface  of  the  neck 
back  upon  the  anterior  aspect  of  the  tra/tsverse  processes  a.nd  diagnosis  of  an- 
terior luxation  be  made. 

VII.  C)€pilus  and  abnormal  mobility  of  bony  parts  indicates   fracture, 

VIII.  The  patient  lies,  and  the  practitioner  stands  at  one  side  of  the 
head,  turns  the  head  slightly  to  one  side  and  passes  the  examining  hand 
transversely  to  the  course  of  the  muscle  fibers,  noting  any  contractures  of  the 
muscles,  superficial  or  deep. 

IX.  He  then  stands  at  the  head  of  the  table  and  examines  both  sides 
of  the  neck  at  the  same  time,  a  hand  upon  each  stde,  carefully  compariiig 
both  sides  with  especial  reference  to  any  abnormality  either  of  bone  or  of 
other  tissue. 

X.  Careful  examination  should  be  made  for  thickening  of  the  tissues 
of  the  neck  just  below  the  occuput. 

XI.  The   scaleni  tnuscles  are  made  prominent  upon  one  side  by  drawing 


I8  CKACTICE  AND  APri.IKD  THERAPEUTICS  OF  OSTEOTATHV. 

the  head  to  the  opposite  side.  They  are  normally  hard  to  the  touch,  and 
care  should  be  taken  in  the  diagnosis  of  contracture.  Tenderness  is  often 
found  upon  pressure,  as  in  cases  of  rheumatism. 

Their  contracture  often  re-^ults  in  drawing  \.\\(t  first  tcvo  ribs   upzvard   out 

of  place. 

XII.  The  brachial  plexus  o{  ner\es  emerges  from  between  the  scalenus 
unticus  and  the  scalenus  niedius  muscles,  below  the  level  of  the  fifth  cervi- 
cal vertebra.  The  head  is  inclined  to  the  side  to  relax  these  muscles,  and 
deep  pressure  is  made  at  this  point  to  impinge  the    plexus.     Tenderness    is 

thus  revealed. 

XIII.  7V;/</^/' <7/vrtj  are  often  found  upon  pressure  in  the  sub-occipital 
fossae.  They  are  due  to  irritation  of  the  ^/ra/ and  .vwfl// (7f«^z7a/  2LX\d  great 
auricular  nerves.  It  is  through  manipulation  of  these  nerves  largely  that 
effects  are  gotten  upon  the  superior  cctvical  ganglia  and  upon  the  medulla. 
They  are  located  at  a  ^^/;// about  two  inches  from  the  middle  of  the  posterior 
margin  of  the  mastoid  process,  in  a  line  at  right  angles  thereto  extending 
toward   the  median  plane  of  the  neck  posteriorly. 

XI\'.  The  superior  cervical  ganglion  lies  in  front  of  the  transverse  pro- 
cesses of  the  second  and  third  cervical  vertebrae,  and  may  be  reached  by 
direct  pressure  through  the  tissues.  The  method  of  locating  the  transverse 
process  of  the  second  cervical  has  been  given  under  V  of  this  chapter.  Deep 
pressure  from  the  anterior  aspect  of  the  neck  may  press  this  ganglion  back 
against  these  processes. 

The  middle  cervical  ganglioji,\y\w^  in  front  of  the  transverse  processes  of 
the  sixth  and  seventh  cervical  vertebrae,  may  be  likewise  reached. 

The  transverse  process  of  the  seventh  cervical  vertebra  is  readily  lo- 
cated  by    deep   lateral    pressure   at  the  outer  third  of  the    su[)ra-cla\icular 

fossa. 

Lesions  of  the  atlas  and  axis  are  b\-  far  the  most  important  occurring 
in  this  region  of  the  bod\-.  and  account  for  many  serious  diseases  of  the 
head  and  its  parts,  such  as  blindness,  insanity,  etc.  The  lesions  of  the  neck 
hold  an  important  relation  also  to  diseases  in  other  parts  of  the  bod)'. 

Comparatively  little  treatment  is  given  directly  to  the  head  and  its 
parts.  These  are  treated  largely  through  the  removal  of  lesion  in  the  neck- 
Hence  the  importance  of  most  thorough  and  careful  attention  to  its  exam- 
ination. 

The  value  of  gently  moving  a  part  \\\\\\e  under  examination  in  order  to  re- 
lax tissues,  to  insinuate  the  examining  fingers  more  deeply  into  them,  and 
to  develop  the  latent  lesion  through  investigation  of  its  relations  to  its 
nci  'hboring  parts  during  movement  must  not  be  overlooked. 


CHAPTER  IV. 
Treatment  of  the  Neck. 

Treatment  of  the  neck,  as  of  other  parts,  is,  in  its  specific  application, 
dAvjdiys  removal  of  lesion.  The  following  general  description  of  methods  of 
work  in  treating  the  neck  is  for  the  purpose  of  laying  before  the  student  in 
a  simple  manner  the  general  principles  involved  in  our  work.  Later  spe- 
cific application  of  these  general  principles  and  methods  will  be  made. 

I.  With  the  patient  prpne,  the  guiding  hand  is  laid  upon  his  forehead 
and  the  head  is  rolled  gently  from  side  to  side  a  few  times  to  aid  in  relax- 
ing the  muscles.  The  fingers  of  the  operating  hand  are  laid,  palm  down, 
upon  the  muscles  of  the  throat  on  the  side  opposite  to  the  practitioner.  As 
the  head  is  moved  away  from  the  practitioner  these  muscles  are  loosened 
through  the  shortening  of  that  side  of  the  neck.  At  the  same  time,  the 
operating  hand  draws  these  muscles  toward  the  median  plane  of  the  neck. 
The  head  may  be  now  moved  from  side  to  side,  while  the  fingers  upon  one 
side  of  the  throat  and  the  thumb  upon  the  other  manipulate  the  tissues. 
All  the  tissues  of  the  anterior  aspect  of  the  throat  may  be  included  in  this 
treatment,  contracture  and  tension  at  any  given  point  being  thus  removed. 
The  treatments  must  be  gentle  in  order  that  sensitive  necks  may  not  be 
irritated. 

The  operating  hand  must  not  be  rubbed  over  the  tissues,  but  they  must 
be  moved  by  the  motion  of  the  hand. 

Holding  or  pressing  gently  but  continuously  against  a  contracture 
while  the  head  is  being  slowly  moved  about  will  relieve  the  tension  and 
remove  the  lesion. 

n.  The  ligaments  of  the  temporo-maxillary  articulations,  and  the 
muscles  and  blood-vessels  below  the  inferior  maxillary  bone  may  be  relieve 
of  tension,  and  be  restored  to  free  action  by  springing  the  mouth  open  againstd 
resistance. 

The  patient  lies  upon  his  back  and  the  practitioner  stands  at  the  head 
of  the  table,  placing  the  palms  of  his  thumbs  upon  the  malar  prominences 
and  the  palms  of  the  fingers  beneath  the  jaw.  The  patient  is  now  directed 
to  open  the  mouth  widely  and  then  to  gradually  close  it.  Resistance  is 
made  by  the  operating  hands  to  the  first  motion,  and  the  fingers  press  the 
superior  hyoid  muscles  downward  and  forward  toward  the  median  plane  of 
the  neck  during  the  second  motion. 

The  ligaments  of  temporo-maxillary  articulations  may  be  sprung  by 
thrusting  a  finger  deeply  into  each  glenoid  fossa  after  the  patient  has 
opened  his  mouth,  nolding  them  there  while  the  mouth  is  shut. 

HI.  The  hyoid  bone  may  be  held  between  the  thumb  and  finger  and  be 
moved  vertically  and  laterally,  stretching  the  hyoid  muscles. 


20  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV. 

l\  .  Pressure  may  be  in  some  measure  applied  to  the  pneumogastric, 
glosso-pharyngeal  and  spinal-aacssory  ncfves  by  deeply  pressing  the  finger 
upward  and  inward  behind  the  angle  of  the  jaw,  in  the  direction  of  the  jug- 
ular foramen. 

Ihc pnt'iitnogastric r\cy\c  may  be  manipulated  by  deep  pressure  behind 
the  anterior  border  of  the  sterno-mastoid  muscle. 

These  three  nerves  are  also  influenced  by  manipulation  upon  their 
closely  related  nerves,  the  sub-occipital,  great  occipital,  small  occipital,  and 
great  auricular,  reached  in  the  sub-occipital  fosscC  as  above  described. 

V.  Pressure  upon  the  phrenic  ncr-ce  may  be  applied  at  the  points 
described  in  Chapter  III. 

VI.  The  sterno-mastoid  muscle  may  be  manipulated  following  the 
method  described  for  treatment  of  muscles  of  the  throat  under  I  of  this 
chapter. 

The  muscle  upon  one  side  may  be  stretched  by  turning  the  head  toward 
that  side  and  slighth'  upward,  thus  increasing  the  distance  between  the 
mastoid  process  and  the  sterno-clavicular  origin  of  the  muscle. 

VII.  The  lateral  and  posterior  juuscles  of  the  neck  may  all  be  treated  in 
a  manner  similar  to  that  described  under  I  of  this  chapter. 

The  practitioner  may  also  stand  at  the  head  of  the  table,  and  with  the 
palms  of  the  hands  upon  each  side  and  the  back  of  the  neck,  gently  grasp 
handfulls  of  the  muscles,  manipulate  them  thoroughly  while  slowly  moving 
the  head  in  all  directions.  Pressure  and  manipulation,  together  with  mo- 
tion, all  gentl}'  and  patientl>'  applied,  will  relax  the  most  obstinate  contrac- 
ture, loosen  all  deep  fibrous  structures,  free  blood-vessels  and  nerves,  and 
prepare  the  way  for  what  is  usually  the  real  object  of  the  treatment,  the  x^- 
i}L\xz\\ov\  oi  bony  lesions.  j     i 

VIII.  With  the  patient  prprae  the  head  is  pushed  as  far  as  may  be 
easily  done  without  resistance,  first  to  one  side  and  then  to  the  other,  and 
it  is  noticed  whether  it  turns  as/ir/  to  one  side  as  to  the  opposite  side.  Inequal- 
it)-  between  the  two  sides  indicates  lesion  usually  upon  the  side  toward 
which  the  head  turns  least  easily. 

After  relaxation  of  the  tissues,  turning  the  head  to  its  limit  toward 
each  side  will  sometimes  aid  in  the  reduction  of  bony  lesion,  especially 
with  the  aid  of  pressure  applied  to  force  the  part  into  its  place. 

IX.  (i)  In  lesion  of  the  atlas  the  patient  lies  prone  and  the  practit- 
ioner, standing  at  the  head  of  the  table,  holds  the  head  between  the  hands, 
with  a  thumb  or  finger  upon  each  transverse  process.  The  head  is  now 
moved  in  a  direction  to  exaggerate  the  jesion,  and  with  traction,  rotation, 
and  pressure  upon  the  processes,  the  atlas  is  forced  toward  its  position. 

(2)  The  operator  may  stand  at  the  side  of  the  head,  one  hand  upon 
the  forehead  and  the  other  pressed  firmly  just  below  the  skull,  »n  the  region 
of  the  lateral  arch  of  the  atlas.  ^Exaggeration  of  the  lesion,  rotation  and 
strong  pressure  aid  in  replacing  the  part. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  21 

(3.)  The  patient  sits  and  the  practitioner,  standing  in  front,  places  one 
knee  beneath  the  chin,  while  the  hands  grasp  the  sides  and  back  of  the 
head.  Exaggeration  of  the  lesion,  traction,  pressure,  and  rotation  are  now 
applied  as  before. 

(4.)  The  patient  sits  and  an  arm  is  passed  about  his  head,  the  bend  of 
the  elbow  coming  beneath  the  occipital  protuberance  and  the  hand  beneath 
the  chin.  The  head  is  now  forcibly  raised  with  the  idea  of  moving  it  upon 
the  spine  in  the  desired  direction,  while  the  free  hand  makes  pressure  upon 
the  spine  in  the  direction  necessar)'  to  aid  in  reposition. 

These  various  treatments  may  be  applied  to  any  of  the  usual  lesions  of 
the  atlas.  The  same  principles  ma}'  be  applied  to  the  different  malpositions 
of  any  of  the  cervical  vertebrae,  generally  patience  and  time  are  necessary 
to  the  gradual  restoration  of  the  bones  to  place.  Much  attention  must  be 
given  to  the  thorough  and  gradual  loosening  of  all  parts  in  preparation  for 
replacement. 

X.  The  axis  is  generally  displaced  laterally.  The  tissues  upon  its 
transverse  and  articular  processes  are  quite  tender  and  contractures  are 
found  in  the  muscles  about  it.  Exaggeration  of  lesion,  rotation  and  pres- 
sure usually  restore  it  to  place. 

XI.  The  scaleni  muscles  may  be  stretched  by  pressing  the  head  down 
toward  the  side  in  question,  pressing  the  fingers  behind  the  clavicle  upon 
the  first  rib  to  force  and  hold  it  down,  while  the  head  is  now  drawn  to  the 
opposite  side. 

XIII.  Thorough  loosening  of  all  cervical  tissues  may  be  accomplished 
by  a  somewhat  ''''spiral"  treatment.  The  patient  lies,  the  guiding  hand  is 
placed  upon  the  forehead,  and  the  other  hand  is  slipped  beneath  the  neck 
and  grasps  it. 

The  head  and  neck  are  now  raised  slightly,  the  head  being  rotated  in 
one  direction,  while,  as  far  as  possible,  exactly  the  opposite  motion  is  given 
the  neck.  The  hand  travels  up  and  down  the  neck,  treating  its  different 
portions  alike. 


CHAPTER  V. 
Osteopathic  Points  Concerning  the  Head  and  its  Parts. 

As  stated,  the  chief  lesions  affecting  the  head  and  its  parts  occur  in  the 
neck,  and  have  already  been  described.  More  detailed  points  in  examnation 
and  treatment  of  these  important  structures  will  be  considered  in  lectures 
upon  their  specific  diseases  in  the  second  part  of  this  work.  The  present 
chapter  will  embrace  only  general  Osteopathic  points. 

Inspection  and  Palpation  are  the  methods  of  examination.  By  the 
former  one  notes  the  size  and  shape  of  the  skull,  the  complexion,  expres- 
sion, eyes,  etc.  By  palpation  he  notes  the  presence  of  tumors  or  other 
growths,  open  fontanelles,  etc. 

A.  The  Eye. 

Those  lesions  most  frequently  affecting  these  organs  occur  at  the  atlas 
and  axis. 

I.  The  coiijujidiva  linitig  the  lids  may  be  examined.  The  lower  lid  is 
ilrawn  out  and  down,  pressure  being  made  at  the  same  time  below  it,  caus- 
ing it  to  become  prominent. 

The  upper  lid  is  turned  back  by  grasping  the  edge  slightly  toward  the 
outer  canthus  and  raising  the  lid,  while  at  the  same  time  pressure  is  made 
upon  it  from  above  near  the  mner  canthus.  This  inverts  the  tarsal  cartil- 
age and  exposes  the  membrane. 

If  while  this  lid  is  turned  back  the  lower  one  is  also  treated  as  above, 
both    together    stand  out  more  prominently  and  may  be  observed  together. 

Granulations  appear  as  minute  white  or  pale  red  elevations. 

II.  With  the  patient  prone,  direct  pressure  is  made,  with  the  palms  of 
the  fingers,  upon  the  eye-balls,  pressing  them  directl}-  back  into  the  orbits. 
This  impinges  nerves,  blood-vessels,  muscles  and  all  the  orbital  structures. 
It  presses  excess  of  blood  from  the  vessels,  and  tones  the  muscles,  nerves 
and  the  structures  of  the  intra-ocular  mechanism. 

III.  Tapping  of  the  eyeball  has  much  the  same  effect.  It  is  performed 
by  placing  the  palms  of  one  or  two  fingers  over  the  closed  eye,  and 
lightly  tapping  them  with  the  index  finger.  Toning  of  the  nerves,  of  the 
ball  and  its  structures,  and  of  the  optic  nerve  is  thus  accomplished. 

IV.  Gyanulations  are  crushed  by  squeezing  them  between  the  fingers 
and  thumb,  the  finger  being  inserted  beneath  the  lid. 

U.  \x\  pterygia,  \.\\e  small  blood-vessels  formed  upon  and  in  the  con- 
junctiva as  feeders,  may  be  broken  up  by  drawing  the  back  portion  of  the 
edge  of  the  finger-nail  across  them.  Care  must  be  taken  not  to  wound  the 
conjunctiva. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  23 

VI.  In  st}'alns7?iHS  the  weakened  or  tensed  muscle  may  be  treated  by 
pressing  the  fingers  into  the  orbit  about  the  eye-bail. 

B.  The  Fifth  Nerve. 

This  nerve  is  reached  at  various  points  about  the  head, as  it  sends  many 
branches  out  over  the  head  and  face.  Its  treatment  is  especially  important 
in  headaches,  neuralgias,  diseases  of  the  e\-e,  iiose,  etc.,  for  the  reason  that 
it  carries  vaso-motor  and  trophic  fibres  to  these  parts. 

I.  Its  supra-orbital  branch  may  be  traced  from  the  supra-orbital  fora- 
men out  over  the  forehead  to  the  temple.  It  forms  an  angle  of  about  fifty 
degrees  with  the  superciliary  ridge.  It  may  be  felt  under  the  skin  like  a 
fine  whip-cord,  and  it  may  be  manipulated  along  its  course  by  passing  the 
fingers  transversely  across  it. 

II.  The  infra-orbital  2,nA  me?ital  hra.nches  may  be  manipulated  at  their 
respective  foramina. 

By  clinching  the  fingers  beneath  the  malar  process  several  branches  of 
the  former  may  be  impinged 

The  tissues  over  the  foramina  and  along  the  courses  of  all  of  these  dif- 
ferent branches  should  be  thoroughly  relaxed  to  remove  irritation. 

III.  A  stipra  trachlear hva.nch  is  located  slightly  to  one  side  of  the  mid- 
line of  the  forehead,  a  lachrymal  branch  about  the  middle  of  the  upper  eye- 
lid, a  temporal  branch  external  to  the  outer  canthus  of  the  eye,  an  infra- 
trachlear  branch  upon  the  nose  opposite  the  inner  canthus,  and  a  7iasal 
branch  at  the  lower  third  of  the  side  of  the  nose. 

All  are  subcutaneous  and  are  readily  manipulated  after  knowing  where 
to  locate  them. 

With  the  EAR,  as  with  the  eye,  lesion  of  the  atlas,  axis,  or  upper  cervi- 
cal region  is  the  most  usual  cause  of  disease. 

The  NOSE,  apart  from  neck  treatment,  is  sometimes  treated  by  local 
mnnipuiation. 

I.  Manipulating  and  loosening  ail  the  tissues  along  the  sides  of  the 
nose  affects  the  blood-supply  of  its  mucous  membrane  through  branches  of 
the  fifth  nerve.     It  will  also  operate  to  free  the  channel  of  the  nasal  duct. 

II.  With  the  patient  '^ryrrp-,  the  palm  of  the  hand  is  placed  upon  the 
forehead,  the  other  hand  is  laid  upon  the  first,  and  the  practitioner,  bending 
over  the  head  of  the  table,  brings  his  weight  upon  the  patient's  forehead. 
This    pressure  is    continued  several   seconds   and  repeated  a  few  times.     It 

frees  the  nostrils   and  in  acute  colds  frequently  at  once   restores    freedom    of 
breathing  through  the  nose. 

The  affect  is  probably  gotten  by  the  pressure  affecting  the  branches  of 
the  fifth  nerve  upon  the  forehead. 

III.  In  colds  and  catarrh  pain  in  X.\\e  frontal  sinus  may  be  relieved  bj' 
lapping  with  the  knuckles  upon  the  frontal  bone  over  the  sinus. 

The  MOUTH  and  throat  are  sometimes  treated  internally    by    sweeping 


24  PRACTICE   AND  AF'PLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

the  palm  of  the  index  finger  from  the  mid-line  of  the  posterior  portion  of 
the  hard  palate  outward  and  downward  over  the  'soft  palate,  pillars  of  the 
fauces,  and  tonsils.  The  uvula  may  also  be  touched.  The  nerves  and 
blood-vessels  of  this  region  are  thus  toned. 

The  Tempro-Maxillakv  Articulations  are  examined.  Inequality  in 
their  action  is  discovered  b\  standing  behind  the  head  of  the  patient,  who 
is  lying '^^fteC'^The  mouth  is  opened  and  closed,  and  deviation  of  the  mid- 
line of  the  chin  from  the  median  plane  of  the  body  noted.  Deviation  of  this 
nature  indicates  luxation  of  one  of  the  articulations,  the  jaw  usually  deviat- 
ing awa\"  from  the  side  of  the  lesion, 

I.  The  ligaments  of  the  articulation  may  first  be  loosened  as  de- 
scribed under  II  of  Chapter  IV.  Pressure  upon  the  opposite  jaw  while  the 
patient  is  closing  the  mouth    will  bring  the  condyle  back  into  place. 

II.  Sometimes  it  is  n?cessary  to  place  a  small  cork  or  piece  of  wood 
between  the  posterior  molar  teeth  upon  the  affected  side.  Pressure  is  now 
made  beneath  the  chin,  tending  to  close  the  mouth,  and  the  jaw  is  slipped 
into  place.  The  corks  may  be  inserted  at  the  same  time  between  the  mol- 
ars of  both  sides  in  case  of  bilateral  luxation 

Treatment  I,  ma\'  be  alternatel)'  applied  in  such  case. 

Opening  the  mouth  against  resistance  (II,  Chap.  IV).  manipulation  of 
the  throat  to  free  the  action  of  the  carotid  arteries,  and  treatment  of  the 
superior  cervical  region  (XIII,  Chap.  Ill)  are,  together  with  removal  of  spe- 
cific lesions,  the  chief  methods  of  treatment  in  diseases  of  the  eye,  ear,  nose 
and  throat.     The\'  produce  affects  by  building  up  the  blood-suppl}'. 


CHAPTER  VI. 
Examination  of  the  Thorax. 

From  an  Osteopathic  point  of  view,  and  not  at  present  considering  the 
contents  of  the  thoracic  cavit)-,  the  examination  of  the  thorax  consists 
mainly  in  discovering,  b)-  palpation  and  inspection,  whether  its  bony  struct- 
ures are  all  in  position. 

Ligamentous  and  muscular  lesions,  also  lesions  of  blood-vessels,  nerves 
and  centers  are  closely  associated  with  bonj'  lesions. 

The  relations  of  the  thorax  to  the  spine  and  to  its  contained  viscera 
cause  its  lesions  to  be  among  the  most  important  ones  found  in  the  body. 
Lesion  of  the  spine,  especially  of  its  thoracic  portion,  often  seriously 
affects  the  thorax  proper. 

Inspection  reveals  change  in  ine  gcrieral  conformation  of  the  thorax.  It 
is  made  with  relation  to  the  spine,  and  effects  of  spinal  irregularities  are 
considered.  Flattening  ox p) ominence  of  the  ribs,  either  in  portions  of  the 
thorax  or  affectmg  it  as  a  whole;  restriction  or  increase  in  the  movements  of 
the  thorax,  upon  one  or  both  sides;  color  of  the  skin,  eruptions,  scars,  etc., 
are  all  noted. 

The  patient  ma)'  sit,  lie,  or  stand  during  inspection,  as  most  convenient. 

Palpation,  the  more  important  method,  proceeds  in  conjunction  with 
further  inspection,  and  is  used  in  the  detection  of  the  various  special  lesions 
to  be  described. 

I.  With  the  patient  standing  or  sitting,  the  palms  of  the  hands  are 
passed  evenly  over  the  anterior  and  posterior  aspects  of  the  chest  <ro?;//>d!;zw^ 
side  with  side\  region  with  region.     The  temperatnre  is  also  noted. 

II.  The /r^fia!rflfza/ region  is  examined  for  any  protrusion  or  retraction 
of  the  thoracic  wall,  significant  with  relation  to  heart  disease. 

III.  Each  lateral  half  of  the  chest  is  examined  for  change  or  lessening 
of  its  antero-posterior  diameter,  considering  the  direction  of  the  component 
ribs  as  well.  Lessening  of  this  diameter,  and  a  tendency  of  the  ribs  to 
greater  obliquity  in  direction,  reveals  2i  flattened  side  ox  sides  of  the  chest. 
This  shows  spinal  lesion  generally,  also  disturbed  ligaments,  blood-vessels, 
nerves,  etc.,  of  all  related  parts.  In  this  case  the  whole  side  is  dropped 
down  and  the  ilio-costal  space  is  lessened. 

IV.  The  same  lesion  may  affect  a  portion  of  the  thorax.  Often  diflat- 
tening  of  the  ribs  posteriorly  beyieath  the  scapula  is  found. 

Protrusions  of  retractions  of  one  area  of  the  chest  generally  correspond 
with  the  reverse  condition  in  the  corresponding  anterior  or  posterior  area. 
This  is  not  true  in  case  of  slipping  of  the  ribs  downward. 

V.  Marked  depression  in  the  supra  or  infra- clavicular  regions  are  sig- 
nificant in  the  diagnosis  of  tuberculosis  of  the  lungs. 


26  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

\'I.  Wilh  Xhc  patient  lying  on  his  side,  the  pa/m  0/ //le  /ia?id  t's  srcepf 
along  the  lakml  aud  postcro-lakral  aspects  of  the  chest,  from  the  shoulder  down- 
wards. Changes  in  the  position  of  the  ribs  individually,  or  in  the  conform- 
ation of  the  side  of  the  thorax  in  question  are  thus  readily  made  out,  mainl>- 
by  detection  of  changes  in  the  angles  of  the  ribs  from   normal. 

The  Sternum  must  be  examined. 

I.  \\.  xv\2iy  he  diSdi  \\'\\o\c,  ptotnided  or  retracted,  following  a  change  in 
the  general  shape  of  the  thorax. 

II.  Luxation  between  Xhejirst and secofid pat ts,  ^n\.Qr\o\\y  ox  \^o->\.e\\n\\y, 
may  occur. 

III.  lYm  ensiform  may  be  displaced  laterally 

The  Clavicle  and  Cokacoid. 

The  latter  is  located  as  the  first  bony  prominence  at  the  outer  end  of 
th*"  infra-clavicular  fossa.     Its  relation  to  the  clavicle  is  to  be  noted. 

The  clavicle  may  be  luxated  at  either  its  sternal  or  acromial  articula- 
tion. The  sternal  end  may  be  upward,  anteriorly  or  posteriorly  from  its 
normal  position.  The  acromial  end  may  be  displaced  downward  toward 
the  coracoid  or  upward  upon  the  acromion  process.  Sometime.s  it  is  tilted 
so  that  one's  fingers  may  be  thrust  far  behinti  its  upper  edge. 

Luxation  of  Ribs. 

One  of  the  main  objects  of  examination  of  the  thorax  is  to  locate  mis- 
placed ribs.  Departures  from  normal  conformation  of  spine  are  at  once 
indications  of  lesion  of  the  several  ribs.  Hence,  following  the  general  ex- 
amination as  outlined  above,  each  rib  in  particular  must  be  scrutinized. 
Landmarks  for  the  location  of  the  various  ribs  should  be  employed. 

I.  Ribs  are  frequently  separated  ox  approximated  beyond  normal  limits. 
These  conditions  are  discovered  by  placing  the  patient  upon  his  side  and 
following  the  successive  intercostal  spaces  with  the  tip  or  side  of  the  ex- 
amining finger.  In  the  latter  lesion  the  tissues  are  lender  along  the  course 
of  the  intercostal  space,  due  to  irritation  of  the  sensor)-  branches  of  the  in- 
tercostal nerves. 

II.  The  same  examination  would  reveal  rotation  of  a  rib  upon  its  hori- 
zontal axis.  In  such  case  the  intercostal  space  is  laiegnally  widened  or  nar- 
rowed. As  a  rule  the  twisting  is  about  the  head  as  a  fixed  point,  and  the 
lower  margin  of  the  rib  is  turned  out  prominenth'.  Then  the  intercostal 
space  next  below  is  narrowed  posteriorly  and  widened  anteriorly.  The  an- 
terior end  is  tended  downward,  luxating  the  costo-chondral  and  the  chon- 
dro-sternal  articulations,  as  it  deranges  the  costal  cartilage.  The  reverse 
rotation  of  the  rib  may  take  place,  making  prominent  the  upper  edge, 
throwing  the  anterior  end  upward,  etc. 

III.  By  various  lesions  of  the  ribs,  ihe  cartilages  are  twisted,  distorted,  or 
torn  loose. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


■^1 


:i 


In  such  case  tender  points  ire  found  upon  pressure  at  the  costo-chond- 
ral  or  chondro-sternal  articulations.  The  cartilage  may  be  ^?</g;^^yf;'z<:.'a;-af 
by  protrusion  of  the  rib,  causing  a  prominent  tender  point.  It  may  be 
retracted,  causing  a  slight  depression. 

With  the  patient  lying  pr^n^,  the  examining  fingers  may  be  carefully 
passed  over  the  successive  pairs  of  cartilages  and  these  lesions  be  noted. 

The  FIRST  RIB  is  located  by  deep  pressure  behmd  the  middle  or  inner  one 
third  of  the  clavicle.  If  the  latter  has  been  found  in  situ,  comparison  with  it 
may  be  made  to  determine  whether  the  rib  be  up  or  down.  By  deep  pres- 
sure the  rib  ma)'  be  traced  well  back  toward  its  head,  which  is  masked  by 
the  posterior  cervical  muscles.  Pressure  may  be  brought  upon  the  head 
at  the  level  of  the  sexenth  cervical  spine,  one  and  one-half  inch  laterally 
therefrom. 

The  sternal  e?id  of  the  rib  is  located  just  below  the  claviculo-sternal  ar- 
ticulation. Its  cartilage  and  may  be  traced  well  outward  an  inch  or  more 
before  disappearing  beneath  the  clavicle. 

Incase  it  may  be  luxated  upward,  the  cartilage  is  retracted,  leaving  a 
flat  area  or  a  depression  at  the  cartilage.  If  downward,  a  protrusion  of  the 
cartilage  at  the  ttd^c  of  the  sternum  is  usual.  In  either  case  the  cartilage 
and    the  tissues  about  the  rib  are  sensitive  to  pressure. 

The  first  and  second  intercostal  spaces  are  wider  than  the  others. 

The  SECOND  RIB  is  located  opposite  the  junction  of  the  first  and  second 
parts  of  the  sternum.  Prominence  or  depression  of  its  cartilage,  and  tend- 
erness in  the  tissues  about  it  are  caused  in  the  same  way  as  in  the  case  of 
the  first.  Its  head  is  located  and  pressure  brought  upon  its  region  at  a 
point  one  and  one  half  inches  external  to  the  first  dorsal  spine. 

The  ELEVENTH  AND  TWELFTH  RIBS  are  more  frequently  luxated  down- 
wards because  of  their  anterior  ends  being  unsupported  and  because  of 
traction  upon  the  latter  by  the  quadratus  lumborum  muscle.  Their  free 
ends  are  readil}'  located  except  when  irritation  from  them,  or  other  cause, 
has  irritated  the  overh'ing  muscles,  causing  hypertrophy  or  contracture.  In 
such  case  they  must  be  located  from  the  tenth  rib. 

The  free  end  of  the  eleventh  lies  well  forward,  thus  distinguishing  it 
from  the  twelfth. 

They  may  be  so  displaced  downward  as  to  be  almost  vertical;  may 
overlap  the  iliac  crest,  or  may  be  luxated  upwards,  the  free  end  of  the 
twelfth  lying  beneath  the  eleventh  or  that  of  the  eleventh  beneath  the 
tenth. 

Frequently  a  luxated  rib  guides  one  to  a  spinal  lesion. 

Displaced  ribs  cause  disease  by  mechanical  interference  with  internal 
viscera,  by  irritation  of  surrounding  soft  tissues,  by  dragging  ligaments,  im- 
pinging nerves,  or  occluding  blood-vessels. 


chaptp:r  VII. 

Treatment  of  Thoracic  Lesions. 

The  thoracic  portion  of  the  spinal  column  is  anatomically  a  part  of  the 
thorax,  but  has  already  been  discussed  under  another  head. 

Osteopathic  treatment  of  the  thorax  is  directed  generally  to  the  res- 
toration of  the  1  ibs  and  other  bony  portions  to  correct  mechanical  relations. 
It  includes  with  this,  work  upon  ligamentous,  cartilaginous,  and  muscular 
lesions,  which  are  usually  secondary  to  bony  lesion.  Thus  while  osteopa- 
thic treatment  of  the  thorax  consists  largely  in  the  putting  of  ribs  into  proper 
position,  this  work  is  always  done  with  an  eye  to  those  other  lesions,  and 
effects  all  surrounding  tissues;  muscles  and  ligiments;  nerves  and  vessels; 
centers  and  viscera. 

Thoracic  is  inseparable  from  spinal  work,  owing  to  the  intimate  anat- 
omical relations  of  these  parts. 

There  are  various  ways  of  setting  ribs.  Many  of  them  rest  upon  the 
principle  that  the  head  of  the  rib,  being  but  slightly  movable,  is  the  fixed 
point;  that  pressure  upon  the  angles  tends  to  move  them  about  this  fixed 
point;  and  that  this  pressure  may  be  guided  and  aided  by  elevation  of  the 
arm  or  rotation  of  the  shoulder,  bringing  traction  upon  the  pectoral  and 
latissimus  dorsi  muscles,  etc.,  which  are  attached  to  the  ribs. 

In  some  treatments,  the  sternal  end  is  made  the  fixed  point  and  the 
parts  are  manipulated  accordingly;  in  some,  both  ends  of  the  rib  are  fixed, 
etc. 

Exaggeration  of  lesion,  fixing  of  a  fulcrum,  traction  upon  attached  tis- 
sues, and  rotation  of  related  parts  are  principles  applied  to  the  work. 

I.  With  the  patient  sitting  upon  the  side  of  the  table,  the  practitioner, 
standing  in  front,  passes  an  arm  about  the  body  of  the  patient,  extending 
his  hand  past  the  spine  behind,  and  pressing  with  the  fingers  upon  the 
angles  of  the  ribs  of  the  further  side.  With  the  other  hand  he  raises  the 
patient's  arm,  of  the  side  in  question,  in  front  of  the  body  and  high  over  the 
head,  rotating  it  downward  and  backward.  This  brings  traction  upon  the 
pectoral  muscles  and  soft  tissues  of  the  whole  anterior  aspect  of  the  side  of 
the  chest,  elevates  the  entire  side,  and  effects  particularly  the  ribs  upon  the 
angles  of  which  pressure  is  made. 

This  motion  may  be  repeated,  the  pressing  hand  traveling  down  the 
back  to  each  successive  rib  in  need  of  treatment. 

This  treatment  elevates  all  the  ribs  and  tones  all  the  connected  muscles, 
ligaments,  vessels,  nerves,  etc. 

II.  The  patient  sits  upon  the  stool;  the  practitioner  stands  behind, 
and,  resting  one  foot  upon  the  stool,  makes  a  fixed  point  of  his  knee  at  the 
angle  of  the  rib  under  treatment.  One  hand  holds  beneath  the  lower  edge 
of  the    ribs,  in    front,  while   the    other  ele\'ates  and  rotates  the  arm  as  in  I. 


30  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

Or  the  first  h.iiui  may  press  clown  upon  the  upper  edge  of  the  rib,  in  front, 
while  the  arm  is  drawn  from  in  front  downwards  to  the  side  of  the  body,  and 
backwards. 

In  these  ways  the  ribs  ma\-  be  forced  downward  or  upward. 

111.  With  the  patient  sitting  or  lying  upon  his  side,  the  rib  is  thrown 
into  action  by  the  patient's  taking  a  full  breath.  The  operating  hands  are 
applied,  one  at  either  end  of  the  rib  in  question,  and  advantage  is  taken  of 
the  relaxation  of  tissues  and  the  motion  of  the  rib  which  take  place  as  the 
patient  expells  the  breath.  The  whole  rib  is  manipulated  at  this  time  to- 
ward its  normal   position. 

This  treatment  is  aided  in  some  cases  by  pushing  the  rib  still  further 
from  its  normal  position  before  an  attempt  is  made  to  restore  it  to  place. 
In  this  wa>  the  principle  of  exaggeration  of  the  lesion   is  called    into  play. 

I\'.  Treatment  II  ma)'  be  applied  with  the  patient  lying  upon  his  side 
instead  of  sitting.  Here  the  practitioner  stands  behinds,  rests  one  foot  upon 
the  table,  bending  his  limb  so  as  to  bring  the  flat  of  his  knee  against  the 
angle  of  the  rib.  The  treatment  then  proceeds  as  in  II.  The  arm  may  be 
rotated  either  forvvard  and  up,  or  downward  and  back,  pressnre  being  made 
at  either  margin  or  at  the  sternal  end  of  the  rib  as  desired.  This  treatment 
allows  the  practitioner  more  latitude  than  does  II. 

Great  caution  must  be  exercised  in  an)-  application  of  the  knee  to  the 
chest,  either  anteriorl)'  or  posteriori)-.  Active  work  with  it  should  be 
avoided,  use  being  made  of  it  only  as  a  fixed  point. 

V.  A  fixed  point  may  be  made  of  the  flat  of  the  knee  at  the  sternal 
end  of  the  rib;  the  arm  of  the  patient  upon  the  same  side  is  manipulated  for 
traction  as  before,  while  the  other  operating  hand  is  passed  over  the 
patient's  opposite  shouldtr  and  applied  to  the  spinal  region  of  the  rib.  This 
treatment   is   applicable  to   luxations   of    the  heads  of  ribs.     The  patient  is 

VI.  With  the  patient  -picme,  the  practitioner  stands  at  one  side  and 
reaches  across  the  patient  to  manipulate  the  ribs  of  the  opposite  side.  One 
hand  is  slipped  beneath  the  back  and  applied  as  a  fixed  point  to  the  angles 
of  any  ribs  in  question;  with  the  other  hand  the  patient's  arm  is  rotated  as 
before  tor  traction.  '^<''^    t 

VII.  With  the  patient  lying ^pmo.  the  practitioner,  standing  at  one 
side,  reaches  across  the  bod)-  and  makes  a  fixed  point  of  his  elbow  upon  the 
angles  of  the  rib.  At  the  same  time  the  hand  of  the  same  arm  grasps  the 
patient's  forearm  upon  that  side  drawing  it  back  and  up.  Thus,  while  the 
rib  is  in  action  the  pressure  of  the  elbow  forces  the  head  into  place. 

VIII.  With  the  patient  lying  sHipin^y  pressure  with  the  operating 
hands  may  be  brought  vertically  downward  upon  heads  or  angles  of  ribs, 
springing  them  into  place.  ,    ^ 

IX.  With  the  patient  lying  pM»*.  the  practitioner  stands  at  the  side 
of  the  table  and  raises  the  patient's  arm  of  the  same  side  to  a  level  with  the 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  31 

shoulder.  With  the  arm  thus  horizontal,  traction  is  made  upon  it,  away 
from  the  body,  and  in  such  a  direciion  as  to  bring  longitudinal  tension  upon 
the  costal  cartilages.  The  other  hand  manipulates  the  cartilage  to  reduce 
any  twist  or  anterior  prominence  of  it. 

X.  With  the  patient  sitting,  the  practitioner  stands  facing  him,  making 
pressure  with  one  hand  upon  the  sternal  end  of  the  rib  in  question.  The 
other  arm  is  passed  about  the  patient's  body,  and  locatfis  and  brings  pres- 
sure upon  the  head  of  the  same  rib.  With  both  ends  of  the  rib  thus  fixed, 
the  motion  of  the  practitioner's  body  is  used  to  rotate  the  patient's  trunk 
about  these  fixed  points,  at  the  same  time  manipulation  is  directed  to  the 
restoration  of  the  rib  to  position. 

It  may  be  said  that  as  a  rule  the  setting  of  a  rib  requires  time  and 
patience,  though  in  many  cases  this  may  be  accomplished  at  once.  It  is 
rarely  the  performance  of  a  set  motion  that  does  this  work.  On  the  con- 
trary, the  practitioner,  with  his  hands  in  position  and  the  parts  under  his 
control  as  described  in  any  particular  treatment,  must  continue  his  efforts, 
with  varying  traction,  pressure,  rotation,  etc.  Movements  of  the  patient's 
whole  trunk,  bending,  turning,  raising  the  parts,  etc.,  may  all  contribute  to 
the  gradual  relaxation  and  yielding  of  the  parts  to  the  persistent,  well 
directed,  and  carefully  judged  efforts  of  the  Osteopath. 

In  the  case  of  the  first  and  second  ribs  many  of  the  general  princi- 
ples and  treatments,  as  already  described,  may  be  applied.  Special  methods, 
however,  are  generally  necessary  to  replace  them.  As  already  stated,  these 
ribs  are  usually  luxated  upwards,  but  may  as  well  be  displaced  downwards. 

I.  Upward  Displacements. 

(i)  The  scaleni  muscles  are  first  relaxed  and  stretched  (Chap.  IV, 
div.  XI),  the  head  is  now  bent  toward  the  shoulder  of  the  affected  side,  and 
and  pressure  is  brought  directly  downward  upon  the  upper  margin,  the 
sternal  or  spinal  end  of  either  or  both  ribs  (Chap.  VI).  In  this  way, 
either  rib  may  be  lowered  as  a  whole  or  at  either  end. 

(2)  With  the  patient  lying  upon  his  back,  the  practitioner  stands  at 
the  head  of  the  table;  presses  the  palm  of  the  thumb  down  upon  the  upper 
margin  of  the  first  rib;  with  the  other  hand  he  raises  the  arm  of  the  patient 
upon  the  side  in  question,  and  pushes  it  across  the  chest  at  the  level  of  the 
shoulder,  thus  relaxing  the  tissues  at  side  of  the  neck,  and  elevating  the 
clavicle  so  that  the  thumb  may  be  thrust  more  deeply  behind  it.  Pressure 
may  be  applied  anywhere  along  the  upper  margin  of  the  rib,  lowering  it  to 
its  normal  position. 

II.  Downward  Displacements. 
( i)     With  the  patient  sitting,  the  practitioner  stands  behind  and  brings 
pressure  with  his  fingers  upon  the  inferior  margin  of  the  first  or  second  rib 
(see  p.  27).     At  the  same  time  the  head  is  bent  to  the  opposite  side,  bring- 
ing traction  upon  the  rib  through   the  scaleni    muscles,   and   rotated    back- 


32  J'KACTICK  .A.Sn  APPLIED  TH  EKAPEUTICS  OF  OSTEOPATHY. 

wards.  This  rotalion  tends  to  bring  more  traction  upon  the  anterior  end 
through  the  scalenus  anticus  (in  case  of  the  first  rib).  This  treatment  may 
be  used  to  elevate  either  rib. 

(2)  The  treatment  as  described  under  II  and  IV  of  this  chapter  may 

be  used. 

(3)  With  the  patient  sitting  and  the  practitioner  standing  in  front, 
pressure  may  be  made  by  the  fingers  below  the  region  of  the  head  of  the 
first  or  second  rib,  (see  p.  27),  while  the  head  is  bent  to  the  opposite  side 
and  rotated  forward.  This  rotation  tends  to  bring  more  traction  upon  the 
posterior  ends  of  the  first  and  second  ribs  through  increased  traction 
respectively  of  the  scalenus  medius  and  scalenus  posticus  muscles. 

(4)  In  case  of  anterior  protrusion  of  the  cartilages  (see  p.  27).  pres- 
sure may  be  brought  upon  them  while  treatment  (I)  above  is    being  given. 

Or  the  patient's  arm  is  raised  to  the  level  of  his  shoulder  and  drawn 
backwards,  bringing  traction  upon  the  cartilages,  while  pressure  is  applied 

to  them. 

The  first  two  ribs  may  be  separated,  to  some  extent,  as  follows:  The 
patient  lies  prone  and  a  hand  is  slipped  beneath  his  shoulder,  bent  to  form 
a  fulcrum  beneath  the  two  ribs;  the  patient's  arm  is  grasped  at  the  elbows 
raised,  and  bent  strongl)-  across  the  anterior  chest  at  the  level  of  the  shoul- 
der. This  tends  tn  drive  the  two  ribs  sternum-ward,  and  to  separate  them 
anteriorl)-  owing  to  the  intercostal  space  being  wider  at  its  anterior  end 
than  at  the  other. 

The  Elev3n  and  Twelfth  Rtbs. 

c 
A.  Downward  Displa^ments. 

A 

A  preliminary  step  must  be  taken  in  the  relaxation  of  all  muscles  and 
tissues  about  the  ribs,  especiall)-  of  the  quadrati  lumborum  muscles.  This 
is  easily  accomplished  by  manipulation  of  the  tissues.  A  special  method 
oi  sttelehing  the  quadrati  \s  :\s  ioWows:  The  patient  lies  upon  his  side  and 
the  practitioner  stands  in  front.  He  grasps  the  arm  of  the  patient  and 
draws  it  diagnonally  forward,  at  the  le\el  of  the  shoulder,  in  a  direction 
awav  from  the  pelvis.  At  the  same  time  his  other  hand  makes  pressure 
upon  the  anterior  iliac  crest  in  a  direction  diagonally  backward,  i.  e.,  in  a 
direction  e.xactly  the  opposite  from  that  in  which  the  arm  is  drawn.  This 
stretches  the  muscle  diagonally  and  rotates  the  lumbar  portion  of  the  spine. 
The  motion  is  now  reversed  by  standing  in  front  of  the  pelvis,  grasping  the 
crest  of  the  ilium,  and  drawing  it  diagonally  forward  in  a  direction  away 
from  the  shoulder.  At  the  8ame  time  the  other  hand  holds  the  bent  arm 
rigid  at  the  side  and  pushes  it  in  a  direction  opposite  from  that  of  the  trac- 
tion applied  to  the  pelvis.  This  motion  gives  the  opposite  diagonal  stretch 
to  the  quadratus  lumborum.  and  rotates  the  lumbar  region  of  the  spine. 

The  eleventh  or  twelfth  rib  itself  is  readil\-  manipulated  upwards  or 
downward  by  taking  advantage  of  three  portion ;(  i  )The  head  usuall>-  remains 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  3 

a  fixed  point,  (2)  Pressure  made  upon  the  outer  aspect  of  the  rib  in  the 
region  of  its  angle  (or  turn  in  case  of  the  twelfth,  which  lacks  the  angle) 
may  be  so  directed  as  to  move  or  rotate  the  rib  upward  or  downward  about 
the  fixed  point,  (3)  The  free  end  may  be  readily  moved  upward  or  down- 
ward by  the  pressure  of  a  finger,  and  this  pressure,  combined  with  pressure 
in  the  opposite  direction  applied  at  the  angle,  readily  rotates  the  rib  about 
its  vertical  axis. 

One  hand  easily  spans  the  rib,  leaving  the  other  hand  free  to  manipu- 
late the  body  and  aid  the  operation.  The  thumb  is  pressed  against  the  free 
end  of  the  rib  and  forces  it  upward  or  downward  while  the  fingers  of  the 
same  hand  bring  pressure  in  the  opposite  direction  at  the  angle  of  the  rib. 
In  this  way  the  rib  is  rotated  about  the  head  as  a  fixed  point  and  may  be 
raised  or  lowered  as  desired. 

I.  With  the  patient  lying  upon  his  side,  his  knees  flexed  and  supported 
against  the  abdomen  of  the  practitioner,  the  operating  hand  manipulates 
the  rib  as  above  described,  forcing  it  upward.  At  the  same  time  the  free 
arm  has  grasped  the  limbs,  raised  them  slightly  to  rotate  the  pelvis  and 
lower  lumbar  spine,  and  thrusts  them  downward  in  extension  to  stretch 
the    soft    tissues  and  aid  in  increasing  the  distance  between  ribs  and  pelvis. 

II.  This  movement  may  be  varied, grasping  the  limbs  in  the  same  way 
and  drawing  them  and  the  pelvis  over  the  side  of  the  table,  rotating  them 
downward  about  the  edge  of  the  table, extending  the  limbs  and  rotating  them 
upward  and  onto  the  table.  The  rib  is  manipulated  as  in  I.  This  is  a 
strong  treatment,  and  applies  great  force  to  the  rib. 

III.  With  the  patient  sitting,  a  hand  is  applid  to  each  end  of  the  rib. 
The  patient  takes  a  full  breath  to  throw  the  rib  into  activity;  pressure  is  so 
applied  as  to  exaggerate  the  lesion,  and  the  rib  is  finally  pressed  upward  to 
its  normal  position  as  the  patient  exhales. 

IV.  The  patient  lies  upon  his  side;  one  operating  hand  grasps  the  ilio- 
costal tissues  and  draws  them  diagonally  downward  and  forward  in  the 
direction  in  which  the  rib  points.  The  other  hand  is  placed  upon  the  angle 
of  the  rib  and  pushes  it  in  the  same  direction.  In  this  way  the  tissues  are 
stretched  and  the  lesion  exaggerated.  The  motion  is  finished  by  an  upward 
turn  of  the  hands,  the  former  pressing  the  end  of  the  rib  upward,  the  latter 
forcing  the  shaft  of  the  rib  upwards. 

B.  Upward  Displacements. 

In  these  cases  the  anterior  ends  of  the  ribs  are  upward  under  the  rib 
above.  All  tissues  are  first  relaxed  as  before,  and  the  free  end  is  located 
by  deep  pressure  beneath  the  ribs  and  tissues.  The  rib  may  be  manipulated 
as  before  described. 

Treatments  I,  II  and  III  may  be  applied  equally  as  well  to  the  reduc- 
tion of  upward  displacements;  the  appropriate  pressure  being  made  to  force 
the  rib  downward. 


34  PRACTICE  AND  AFPLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

The  STERNUM,  if  PROTRUDED  or  RETRACTED  as  a  vvhole,  is  restored  to 
normal  through  the  general  shaping  of  the  thorax  b\'  methods  already 
described.  The  cnsifcrm  appendix,  being  cartilaginous,  is  usually  easily 
sprung  by  pressure  and  trained  toward  its  normal  position. 

In  case  of  lu.xation  between  \.\\^  first  and  second  parts  of  the  sternum, 
traction  is  brought  upon  the  first  part  through  the  deep  cervical  tissues  and 
the  sterno-mastoid  muscle  of  either  side  by  rotation  of  the  head  backward 
and  to  one  side.  At  the  same  time  pressure  is  made  upon  the  prominent 
end  of  the  first  or  second  i)art,  reducing  it. 

The  CLAVICLE  may  be  restored  from  any  of  its  usual  mal-posicions  as 
follows:  The  patient  lies  prone  and  the  practitioner  stands  at  the  head  of 
the  table,  slightl)-  to  one  side.  The  fingers  of  the  operating  hand  are 
pressed,  palm  up,  behind  the  clavicle,  the  tissues  being  relaxed  by  slightly 
raising  the  shoulder.  The  free  hand  now  grasps  the  arm  of  the  patient  just 
above  the  elbow  and  pushes  the  bent  arm  across  the  chest,  up  over  the  face, 
above  the  head,  and  rotates  it  down  to  the  side  again.  This  motion  has 
raised  the  clavicle  and  allowed  the  fingers  to  be  pressed  deeply  behind  it. 
They  may  be  applied  particularly  to  the  steinal  end.  The  elevation  of  the 
shoulder  has  widened  the  anterior  end  of  the  costo-clavicular  space  and 
allowed  the  fingers  to  be  brought  well  forward  toward  the  sternal  end.  As 
the  arm  is  now  rotated  outward,  the  increase  of  distance  between  the  sternal 
and  acromial  attachments  of  the  bone  draws  it  down  hard  upon  the  fingers 
between  it  and  the  rib,  forcing  it  upward  from  either  an  anterior  or  posterior 
down-ward  dislocation. 

In  case  the  sternal  end  had  been  dislocated  npzvard  on  the  sternum,  the 
motion  would  have  been  the  same,  except  that  during  the  outward  rotation 
of  the  arm  pressure  would  have  been  made  above  the  sternal  end  to  force  it 
downward. 

In  case  the  acromial  end  had  been  downward  or  up-ward  the  same  motion 
would  be  applied,  with  the  operating  hand  directed  to  that  end  of  the  bone. 
During  the  outward  rotation  of  the  arm  the  bone  would  be  grasped  between 
the  fingers  behind  and  the  thumb  in  front  and  moved  upward  or  downward 
from  its  displacement. 

Here,  as  in  case  of  the  ribs,  it  is  less  probable  that  the  performance  of 
a  single  set  motion  would  accomplish  the  work  than  that  insistent,  though 
not  violent,  traction,  pressure,  rotation,  etc.,  according  to  the  manner  of  the 
described  treatment,  would  secure  the  result. 


CHAPTER  VIII. 
General   Osteopathic    Points    In    Regard   To   The  Abdomen  And  Its 

Parts. 

Many  of  the  specific  lesions  affecting  the  abdomen  and  its  contained 
viscera  occur  in  the  spine  and  thorax  and  are  of  kinds  already  described. 
Much  of  the  treatment  for  diseases  of  these  parts  is  upon  such  lesions.  The 
subject  of  examination  and  treatment  of  the  various  organs  will  be  consid- 
ered more  in  detail  in  relation  to  their  specific  diseases.  The  aim  of  this 
chapter  is  to  give  general  methods  of  examination  and  general  osteopathic 
points  concerning  these  parts. 

Position: — The  patient  lies  pr-o^c:  the  thighs  are  flexed  and  the  feet 
rest  upon  the  table;  the  head  and  chest  are  slightly  elevated  by  the  in- 
clined head  of  the  table.  In  this  position  the  abdominal  muscles  are  re- 
laxed. The  sides  of  the  body  are  disposed  alike  to  avoid  unequal  tension 
upon  the  tissues. 

Inspection,  palpation,  percussion  are  the  physical   methods  employed. 

Inspection  reveals  enlargement  due  to  gas  or  fluid,  tumor,  muscular 
contraction,  etc.;  color,  distended  or  retracted  walls,  restricted  or  increased 
motion,  pulsation  or  engorgement  of  blood  vessels,  etc. 

Palpation  reveals  change  in  temperature;  tumors,  superficial  or  deep, 
fluid  or  solid;  tenseness  or  flabbiness  of  the  abdominal  walls;  enlargements 
and  displacements  of  organs,  etc. 

Percussion  reveals  the  limits  of  organs,  pressure  of  tumors,  fluids  or 
gases,  etc. 

Ausculation  reveals  the  gurgling  of  gases,  fetal  sounds,  lubrication  of 
the  bowel,  etc 

I.  h  general  treatment  of  ihe  abdomen  is  sometimes  necessary  for 
general  relaxation  of  the  abdominal  w^alls,  often  as  a  preliminary  step  to- 
ward further  examination.  With  the  patient  in  position  as  above,  the  prac- 
titioner stands  at  the  side  of  the  table  and  with  the  palm  of  the  hand  man- 
ipulates the  tissues  to  relax  them.  Care  should  be  taken  to  avoid  pressure 
with  the  tips  of  the  fingers  or  other  rude  work  which  causes  the  tissues  to 
contract.  The  hand  should  be  warm  and  the  manipulation  gentle  but 
thorough. 

II.  Direct  manipulation,  including  pressure  and  various  movements, 
is  often  made  upon  the  various  abdominal  organs.  Specific  directions  for 
the  treatment  of  any  given  organ  are  reserved  until  specific  diseases  of  these 
organs  are  considered.  But  speaking  in  general  of  abdominal  manipulation 
as  one  of  the  methods  in  the  repertoire  of  the  Osteopath,  care  must  be 
taken  to  make  clear  the  difference  between  such  manipulation  and  massage. 
Here  the  mode  of  motion  is  relatively  insignificant.  The  manipulation  is 
not  for  the  general  effect  following  a  thorough  abdominal  massage,   but    is 


36  PRACTICE  AND  APF'LIED  THERAPEUTICS  OF  OSTEOPATHY. 

corrective;  directed  to  the  specific  end  of  restoring  to  proper  mechanical 
relations  an  organ  or  organs  definitely  ascertained  to  be  in  need  of  mechan- 
ical adjustment.  Here,  as  elsewhere  in  the  body,  this  work  removes  pres- 
sure from,  or  interference  with,  blood-vessels  and  nerves.  For  example, 
osteopathic  treatment  of  the  colon  is  not  made  for  general  manipulative  ef- 
fect, but  is  directed  to  raising  and  straightening  a  sigmoid  too  much  bent  or 
folded.  Thus  it  removes  a  mechanical  obstruction  to  bowel  action,  but  also 
lets  free  pelvic  circulation  and  nerve  action  impeded    by  such  a    condition. 

Or  manipulation  of  the  colon  raises  from  its  unnatural  position  the  gut 
which  has  prolapsed  anti  become  wedged  down  among  the  peKic  viscera, 
where  it  has  destro\ed  harmony  of  the  functions.  Osteopathic  manipula- 
tion in  this  way  is  specific;  corrective;  bRsed  upon  mechanical  principles, 
and  is  applied  b\' a  practitioner  who  knows  what  causes  such  abdominal 
conditions  and  how  to  correct  them. 

III.  With  the  patient  in  position  as  above,  or  standing  or  sitting  bent 
well  forward,  the  fingers  are  inserted  deeply  beneath  the  viscera  in  each  il- 
iac fossa.  They  are  now  drawn  directly  upward,  raising  all  the  pelvic  and 
abdominal  viscera,  freeing  the  action  of  the  femoral  and  pelvic  vessels  and 
nerves. 

In  case  the  patient  has  bent  forward  he  straightens  the  body  again  at 
the  same  time  the  viscera  are  raised. 

I\'.  With  the  patient  l\ing  upon  the  right  side,  the  practitioner  stands 
behind  the  pelvis  and  presses  llie  fingers  deeply  into  the  iliac  fossa  upon 
the  side  of  the  sigmoid  nearest  the  median  plane  of  the  body.  He  now 
raises  the  sigmoid  flexure  upward  and  slightly  outward  over  the  flaring  il- 
ium. This  raises  the  gut  from  the  pelvis,  relieves  kinking,  and  frees  the 
circulation  of  the  part. 

The  movement  may  be  repeated  for  the  caecum. 

V.  With  the  patient  in  the  dorsal  position,  the  practitioner  stands  at 
the  side  and  places  the  palms  of  the  hands  over  the  false  ribs  and  carti- 
lages, one  on  either  side,  heel  out  and  fingers  directed  toward  the  median 
plane  of  the  body.  Pressure  is  now  made  evenly  upon  the  sides,  springing 
the  ribs  and  cartilages  down  upon  the  viscera  beneath.  As  the  pressure  is 
directed  inward  the  ribs  and  cartilages  are  forced  toward  the  mid-line  and 
pressed  down  upon  the  viscera.  Repeating  this  motion  at  intervals  of  a 
few  seconds  thoroughly  tones  the  nerve  plexuses  and  blood-flow  of  the  up- 
per abdominal  viscera. 

VI.  Deep  pressure  is  made  upon  the  solar  plexus  as  follows:  The  pitient 
lies  prone,  the  practitioner  stands  at  the  side  and  lays  the  palmar  surface 
of  the  distal  phalanges  of  one  hand  over  the  pit  of  the  stomach,  at  the  level 
of  the  tips  of  the  seventh  and  eighth  ribs.  Pressure  with  the  second  hand 
upon  the  first  is  gradually  applied,  the  hand  sinking  deeper  into  the  tissues 
until  very  deep  pressure  has  been  made.  The  plexus  may  now  be  manipu- 
lated by  a  slight  circular  movement  of  the  hand.     This  treatment  tones  the 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  37 

action  of  the  solar  plexus,  etc.     It  should  be  gently  and  gradually  applied, 
but  the  pressure  must  be  considerable. 

VII.  Deep  pressure  as  above  at  any  point  will  cause  a  purely  nervous 
pain  to  lessen  or  disappear,  while  it  increases  a  pain  due  to  inflammation. 

VIII.  Displaced  ribs  sometimes  mechanicaliy  depress  viscera,  and 
must  then  be  replaced  by  methods  already  described, 

IX.  The  fundus  of  the  gall  bladder  is  reached  by  deep  pressure  beneath 
the  tip  of  the  ninth  rib  on  the  right  ride.  Thence  the  course  of  the  bile 
duct  to  the  duodenum  is  in  the  shape  of  a  reversed  "S,"  the  upper  limb  lying 
above  and  to  the  right  of  the  umbilicus,  the  lower  limb  encircling  the  um- 
bilicus upon  the  right  and  opening  into  the  duodenum  from  one  to  two 
inches  below  the  umbilicus.  Manipulation  aids  in  empt}ing  the  bladder 
and  in  passing  gall  stones  along  the  duct. 

Abdominal  treatment  is  geneaally  in  conjunction  with  treatment  upon 
specific  lesion  occurring  in  the  spine,  thorax,  etc.  It  must  be  given  care- 
fully, as  there  are  many  diseases,  e.  g.,  typhoid,  in  which  rough  abdominal 
treatment  might  cause  serious  injury.  It  is  directed  to  a  specific  end  and 
restores  mechanical  relations  of  parts,  frees  nerve  and  blood  mechanisms, 
removes  muscular  contracture,  etc. 


CHAPTER  IX. 
Examination  and  Treatment  of  Lesions  of  the  Pelvis. 

Importance  of  pelvic  lesion  can  scarcely  be  overestimated  on  account  of  its 
relations  to  the  spine  above,  to  its  contained  viscera,  and  to  the  lower  portions 
of  the  body.  This  chapter  does  not  deal  with  diseases  of  the  pelvic  organs, 
but  with  bony  and  ligamentous  lesions  of  the  pelvis  which  are  so  significant 
from  the  osteopathic  standpoint,  as  causes  of  disease  in  the  pelvic  viscera  in 
the  limbs,  or  in  the  body  above. 

A.     Lesions  Affecting  the  Pelvis  as  a  Whole: 

I.  Examination.  The  examiner  must  not  neglect  to  examine  the  spine 
in  relation  to  pelvic  lesion,  as  malpositions  of  this  structure  are  almost  sure  to 
destroy  spinal  equilibrium  and  thus  to  effect  spinal  relations,  sometimes  to  a 
serious  extent.  The  most  common  of  such  results  is  swerving  or  curvature  of 
the  spine  in  respon.se  to  the  efforts  of  nature  to  adapt  the  spine  to  a  crooked 
pelvis. 

The  pelvis  as  a  whole  may  be  tipped  forward  or  backward;  may  be  turned  to 
eillicr  sidc\  ox  mdiy  ht  tilted,  throwing  one  crest  up  and  the  other  downivard. 
The.se  malpositions  may  be  combined  in  various  ways.  The  g- en eral  symptoms 
of  such  trouble  are  pelvic  diseases,  female  disorders,  backache,  sciatica,  lame- 
ness or  paralysis  of  the  lower  limbs,  etc.  In  case  of  lesion  of  the  whole  pelvis, 
the  point  of  movement  upon  the  spine  is  usually  the  lumbo-sacral  articulation, 
but  the  fifth  lumbar  vertebra  may  be  carried  with  the  pelvis,  or  the  yielding 
point  may  include  the  whole  lumbar  region. 

Inspection  and  Palpation  aid  each  other  in  the  examination. 

(I.)  Both  superior  posterior  iliac  spines  are  found  equally  \.oo  prominent  in 
case  of  backward  luxation  of  the  pelvis,  or 

(2)  They  are  alike  found  to  have  receded  anteriorly  in  forward  luxation,  or 

(3)  One  is  prominent  and  the  other  has  receded  anteriorly  in  twisting  of 
the  pelvis  sidewi.se  or. 

(4)  One  stands  higher  than  the  other  in  case  of  tilting  of  the  pelvis  lat- 
erally. In  the  latter  case  comparison  shows /wr^/^a///;!' /;z  the  length  of  the 
limbs,  and  tenderness  is  often  found  in  the  tissues  upon  the  iliac  crest  of 
the  low  side  owing  to  greater  tension  upon  them.  At  the  same  time  the  7vaist 
line  is  deepe7ied  w^on  the  high  side  and  filled  out  upon  the  low  side. 

Examination  and  comparison  of  the  posterior  superior  spines  is  best  made 
upon  the  bared  back,  with  the  patient  sitting  sidewise  upon  the  table.  The 
practitioner  sits  upon  a  low  .stocl  directly  behind  the  patient,  placing  a  hand 
upon  each  spine,  examining  and  comparing  them  carefully.  Care  must  be 
taken  that  careless  posture  of  the  patient  does  not  cause  an  apparent  inequal- 
ity, or,  on  the  other  hand,  that  an  assumed  position  does  not    mask  the    lesion. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  '5J9 

With  the  patient  sitting  or  lying  on  the  side,  careful  palpation  is  made  of 
the  superficial  and  deep  soft  tissues  in  the  sacro-iliac  and  posterior  sacral 
regions.  These  are  commonly  sensitive  to  pressure,  but  are  always  tensed, 
congested  and  strained  over  the  sacro-iliac  articulation  and  the  posterior  sacral 
foramina.  These  ligamentous  lesions  alone  cause  much  ill  by  obstructing 
nerve  action.  The  hand  is  also  passed  along  the  crests  of  the  ilia  making 
deep  pressure  in  the  tissues,  to  discover  tenderness  in  them. 

Tilting  of  the  pelvis  may  be  ascertained  also  by  measurements  between 
the  coracoid  process  of  the  scapula  and  the  anterior  superior  spine  of  the  ilium 
upon  each  side.  A  better  method  is  to  have  the  patient  hold  the  tape  between 
his  teeth  in  the  mid-line  of  the  body,  from  which  point  measurement  is  made 
to  the  inner  maleolus  of  the  tibia  on  each  side.  Tilting  of  the  pelvis  cannot  be 
ascertained  by  measurements  unless  a  fixed  point  above  the  pelvis  is  used  as 
the  starting  point. 

II.     Treatment. 

In  the  treatment  of  all  the  lesions  above  described,  a  preliminary  step  may 
usually  be  made  with  advantage  by  thorough  relaxation  of  the  soft  tissues  in 
the  sacro-iliac  regions  as  already  described.  (Chap.  II,  divs.  Ill,  XIII,  XIV, 
XIX.) 

All  the  lesions  described  may  be  treated  with  the  patient  sitting  upon  the 
stool,  his  pelvis  fixed  by  an'assistant,  who  stands  in  front  or  behind  and  grasps 
the  iliac  crests,  one  with  each  hand. 

(i)  For  backward  tipping ,  the  assistant  stands  in  front  and  draws  the  pel- 
vis forward,  while  the  practitioner  stands  behind,  grasps  the  patient  beneath 
the  axillae,  and  raises  and  draws  the  trunk  backward.  His  work  is  aided  by 
pressure  of  his  knee  against  the  sacrum.  During  this  treatment, 'slight  rota- 
tion of  the  body  from  one  side  to  the  other  during  the  lifting  process  helps  the 
reduction  of  the  lesion. 

(2)  For  tilting  tipward  on  one  side  or  for  ttirning  to  either  side,  this  same 
treatment  may  be  applied  with  variations  to  suit  the  condition. 

(3)  For /?)^^?«^/<?r7£'^r</,  the  assistant  stands  behind  and  draws  the  pel- 
vis backward,  while  the  practitioner  manipulates  the  trunk  from  in  front,  in  a 
similar  manner  as  before,  gradually  working  and  drawing  it  forward. 

(4)  For  tipping  forward,  the  patient  may  lie  upon  his  side,  the  practitioner 
stands  behind  the  pelvis,  making  a  fixed  point  with  one  palm  against  the  lower 
portions  of  the  innominates  and  sacrum,  He  now  draws  backward,  with  the 
other  hand,  upon  the  uppermost  iliac  crest  and  anterior  superior  spine.  The 
patient  lies  upon  the  other  side  and  the  motion  is  repeated. 

(5)  For  tipping  backward,  the  patient  lies  upon  his  side,  the  practitioner 
stands  behind  and  presses  the  flat  of  his  knee  against  the  upper  portion  of  the 
sacrum.  He  now  grasps  the  uppermost  limb  with  one  hand,  the  uppermost 
shoulder  with  the  other,  and  draws  the  body  backward,  while  forcing  the  pel- 
vis carefully  forward. 


40  I'RACTICE  .AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

(6)  For  tiltijig  upicard  of  the  pelvis,  one  may  adapt  to  the  reduction  of 
this  lesion  the  treatment  described  in  Chap.  VII,  A,  Downward  Displace- 
ments of  Lower  Ribs,  for  the  stretching  of  the  quadrati  lumborum  muscles. 

(7)  For  turning  of  the  pdvis  to  one  side,  one  may  adapt  to  the  reduction  of 
this  lesion  the  treatment  as  described  in  Chap.  II.  div.  XVIII,  third  treatment. 


CHAPTP:R  IX  —Continued. 
B. — Lesions  Affecting  Parts  of  the  Pelvis. 

We  deal  here  chiefly  with  lesions  of  the  innominate  bones.  They  are 
more  frequent  than  lesions  of  the  pelvis  as  a  whole,  and  are  realatively  more 
important. 

The  gcnoal  indications  of  innominate  lesion,  which  would  lead  one  to 
examine  tor  such  displacement  are  back-ache,  sciatica,  pain  or  lameness  in. 
the  limbs,  limping  or  unequal  gait,  pelvic  disease,  female  disorders,  etc. 

The  lesions  of  the  innominates    commonly  met  with  are: 

I.  The  innominate  di\s\^\?iC^(\  forivard  or  backward. 

II.  The  innominate  displaced  npzvard  or  dotvn'iCard. 

III.  Combinations  of  tJic  above,  which  are  the  rule.  It  is  rare  that  the 
simple  lesion  I.  or  II.  is  found.  Frequently  the  displacement  is  doivmvard' 
and  backcvard  at  the  same  time,  lengthening  the  leg.  This  lesion  is,  on  the 
whole,  the  most  common,  but  the  opposite  \ux^i\on,  forzua'd  and  upzvard,  is 
frequent.  Generally  if  the  lesion  is  backward,  it  is  at  the  same  time  down- 
ward; if  it  is  forward,  it  is  at  the  same  time  upward.  In  thela'cter  case,  the 
leg  is  shortened.  Yet  it  cannot  be  stated  as  the  invariable  rule  that  the 
backward  lesion  is  combined  with  the  downward  one,  and  that  the  upward 
and  forward  positions  alwa)-s  combine.  The  luxation  may  be  back  and  up,, 
or  vice-versa.  Yet,  whatever  the  combined  lesion  be,  a  lengthened  limb  in- 
dicates a  downward  displacement  of  the  innominate,  while  a  shortened 
limb  shows  the  reverse. 

The  reason  why  the  downward  lesion  usually  complicates  the  backward 
one  is  found  in  the  beveled  edge  of  the  sacrum  where  it  articulates  with  the 
ilium.  This  bevel  is  wedge-shaped,  with  its  broad  end  up.  Moreover,  its 
posterior  margin  is  longer,  and  rises  higher  than  its  anterior  edge.  Thus 
the  beveled  auricular  surface  of  the  sacrum,  which  bone  is  broader  in  front 
and  tilts  forward  so  that  the  posterior  margin  of  its  base  stands  higher, 
directs  the  ilium  either  downward  and  backward,  or  upward  and  forward,, 
according  to  the  direction  of  the  forces  causing  the  lesion. 

IV.  Each  innominate  may  suffer  from  lesion  at  the  same  time,  which 
may  be  alike  upon  both  sides,  or  different. 

Examination:  Palpation,  aided  by  Inspection,  is  used  in  the  examina- 
tion. 

I.  The  length  of  the  limbs  is  compared,  and  is  one  of  the  first  and  most 
reliable  methods  of  examining  for  lesion  of  the  innominate.  The  patient 
is  laid  upon  his  back;  care  is  taken  that  he  shall  lie  perfectly  straight;  the 
limbs  are  flexed  and  rotated  to  relax  muscles  and  ligaments,  and  to  pre- 
vent any  unnatural  tension  in  these  structures  from  causing  merely  appar- 
ent difference  in  length.  The  limbs  are  now  drawn  down  and  compared  at 
the  heels.    It  is  best  to  have  the  patient  keep  the  shoes    on,   but  care   must 


42  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

be  taken  to  notice  that  the  heels  of  the  shoes  do  not  differ  in  thickness,  and 
that  they  are  pushed  back  snugly  against  the  patient's  heel. 

This  examination  is  for  confirmation  only,  and  while  it  is  a  clear  indi- 
cation that  one  innominate  is  lu.xated,  further  examination  is  necessary  to 
determine  whether  one  leg  is  too  long,  or  the  other  too  short. 

II,  Toidinicss  in  the  sacro-iliac  ligaments  upon  deep  pressure,  and 
tenderness  in  the  tissues  along  the  crest  of  the  ilium  indicate  that  the  lesion 
is  upon  the  side  upon  which  such  tenderness  occurs.  The  sacroiliac  liga- 
ments are  found  tensed  upon  the  side  of  lesion. 

While  this  tenderness  and  tension  will  usually  indicate  unilateral  lesion 
it  is  not  an  in\ariable  sign,  as  the  strain  thrown  upon  the  opposite  side  often 
causes  like  effects. 

7V>fderfi(Ss  at  Ihc public  symphysis  is  often  present  in  these  cases. 

'\\\c  posHioa  of  the  posterior  superior  iliac  spines  is  the  best  indication  of 
lesion,  receding  anteriorly,  prominent  posteriorly,  up,  or  down,  down 
anti  back,  forward  and  up,  etc.,  indicating  the  corresponding  malposition  in 
the  bone.  Comparison  of  the  spine  of  the  luxated  bone  with  that  of  the 
normal  bone  is  made.  This  examination  must  be  made  upon  the  bared 
back  with  the  patient  sitting.  The  practitioner  sits  directly  behind  the 
patient,  palpation  of  both  spines  alike  is  made  at  the  same  time,  one  hand 
upon  each.     This  facilitates  comparison. 

I\'.  The  ti'rt/i/ //wi' is  frequentlx  changed  in  each  case.  Usually  that 
upon  the  side  of  lesion  is  deeper  through  the  patient's  favoring  that  side; 
bending  toward  it.  For  the  same  reason  the  muscles  about  the  hip,  peh'is 
and  lower  spine  upon  the  opposite  side  may  be  hypertrophied, 

\ .  The  spiiie  adjacent  to  the  peh'is  must  be  examined  for  curvature, 
swerving  to  one  side,  hypertroph}-  or  tension  of  tissues,  etc.,  secondary  to 
pelvic  lesion. 

\T.  Measurements  may  be  made  between  coracoiJs  and  anterior  super- 
ior spines,  also  from  the  mid-line  of  the  teeth  to  the  inner  maleolus  of  each 
tibia. 

Treatment:  Preliminar}"  relaxation  of  all  surrounding  tissues  is  first 
done  by  methods  already   described. 

I.     Backward  Luxations  and  their  combinations: 

a.  Patient  lies  upon  his  back;  practitioner  stands  at  the  side  and  places 
the  clenched  hand  as  a  fixed  point  beneath  the  posterior  superior  spine  of 
the  luxated  bone;  the  knee  is  flexed  against  the  throax  and  is  rotated 
outward  strongly  enough  to  raise  the  weight  of  the  patient  and  throw  it  up- 
on the  clenched  hand.  In  this  way  the  weight  of  the  body  is  made  to  force 
the  bone  forward. 

b.  Patient  lies  upon  his  side;  practitioner  stands  in  front  of  the  pelvis, 
slips  one  hand  between  the  thighs  and  grasps  the  tuberosity  of  the  ischium, 
the  other  hand  is  upon  the  posterior  crest.  He  now  draws  forward  upon 
the  latter  point  while  he  pushes  backward  upon  the  tuberosity,    by    pulling 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


43 


forward  on  the  tuberosity  and  pushing  backward  on  the  crest,    the  anterio) 
displacement  of  the    bone   may  be    set. 

Commonly  one  alternately  pushes  and  pulls  to  thoroughly  loosen  the  bone, 
ending  by  the  appropriate  motion  to  set  it. 

c.  Patient  lies  upon  his  sound  side;  practitioner  stands  behind  the  pel- 
vis .making  pressure  with  his  hand  upon  the  upper  back  part  of  the  in- 
nominate, while  at  the  same  time  he  draws  the  uppermost  thigh  backward. 
This  forces  the  bone  forward. 

II.      Forward  Luxations  and  their  combinations: 

a.  Patient  lies  on  his  side,  lesion  uppermost;  the  practitioner  stands 
behind  the  sacrum  and  places  his  hand  or  the  flat  surface  of  his  knee  against 
the  lower  part  of  the  sacrum,  while  he  draws  backward  upon  the  anterior 
spine  and  crest  of  the  luxated  innominate. 

b.  See  "b"  above. 
III.     Upward  Lesion: 

a.  The  patient  sits  upon  a  stool  and  an  assistant  stands  in  front  and 
fixes  the  pelvis  by  firm  pressure  downward  upon  the  crests  of  the  ilia.  The 
practitioner  stands  behind,  grasps  the  patient's  trunk  beneath  the  axillae, 
and  lifts;  turns  and  springs  the  whole  trunk  away  from  the  side  of  lesion. 

This  same  motion  may  be  applied  to  forcing  the  body  down  toward  the 
side  of  lesion  in  downward  luxations. 

b.  For  reducing  the  upward  lesion  one  may  adopt  the  treatment  de- 
scribed in  chapter  VII.  a.  for  the  stretching  of  of  the  quadratus  lumborum 
muscle. 

For  do7u?iward  luxation  see  "a"  above. 

The  SACRUM  and  cocoyx  have  already  been  discussed.  (Chap.  I.  divs. 
v.,  VI.,  VII  ;  Chap.  II.  divs.  XIX.,  XX.)  Anterior  or  posterior,  upward  or 
downward  luxation  of  the  sacrum  may  be  overcome  by  combinations  of  the 
treatments  described  for  the  sacrum  and  for  the  innominate. 

Spinal  treatment  must  be  given  in  conjunction  with  pelvic  treatment  as 
the  case  ma}'  require. 

C. — General  Points  Concerning  the  Pelvis. 

The  piidic  nerve  a?id  artery  may  be  located  where  they  cross  the  spine 
of  the  ischium,  and  be  reached  by  deep  pressure.  The  patient  lies  upon 
his  side,  the  practitioner  stands  in  front  and  bends  the  uppermost  thigh 
backward  to  loosen  the  muscles  and  tissues.  Pressure  is  made  down  upon 
the  spine  at  a  point  between  the  middle  and  lower  two  thirds  of  a  line 
drawn  from  the  posterior  superior  spine  of  the  ilium  to  the  outer  side  of  the 
tuber  ischii. 

The  gluteal  arteries  may  be  impinged  in  the  same  way  by  deep  pressure 
at  a  point  between  the  upper  and  middle  two  thirds  of  a  line  drawn  from 
the  posterior  superior  spine  of  the  ilium  to  the  outer  side  of  the  great  troch- 
anter when  the  thigh  has  been  rotated  forward. 


.^  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

Deep  manipulation  may  be  made  over  the  course  of  the  ihac  blood-ves- 
sels, beginning  at  a  point  about  two  inches  below  the  umbilicus  and  thence 
diagonally  outward  to  the  point  where  the  femoral  vessel  leaves  the  pelvis 
beneath  Poupart's  ligament.  The  internal  iliac  artery  runs  diagonally 
downward  into  the  pelvis  from  about  the  mid-point  of  the  line  of  the  first 
manipulation. 

lYic  speniiatii  or  ovarian  vessels  may  be  manipulated  by  deep  pressure 
alono  a  line  beginning  at  the  level  of  the  umbilicus  one  inch  external  there- 
to, and  running  down  to  enter  the  pelvis  at  a  point  one  and  one  half  inches 
internal  to  the  anterior  superior  spine  of  the  ilium. 

In  case  of  these  \esstls  one  aids  the  venous  flow  by  centripetal  pro- 
gress along  the  lines  defined.  As  an  aid  in  relieving  or  restoring  blood- 
flow  in  various  pelvic  diseases  the  treatments  are  of  value. 

The  Hy/>os^astrie plex2(S  is  reached  by  deep  pressure  at  a  point  about  two 
inches  below  the  umbilicus.  The  plexus  lies  between  the  common  iliac 
arteries,  just  below  the  bifurcation  of  the  aorta. 

The  pelvie plexuses  a.re  reached  a  little  lower  and  outward  from  the  mid- 
line, where  they  lie  deep  in  the  pelvis  each  side  of  the  rectum. 

D. — Osteopathic  Work  i-er  Rectum. 

The  index  finger  is  generall)'  used  in  rectal  work  as  its  use  is  less  inter- 
fered with  by  the  knuckles.  Proper  precautions  for  cleanliness  and  to 
guard  against  infection  must  be  employed.  The  patient  lies  upon  the  right 
side  or  stands  bent  over  a  table.  The  examining  finger,  lubricated  with 
vaseline  or  soap-suds  is  inserted,  palm  down,  into  the  rectum.  It  notes  mal- 
position of  sacrum  or  coccyx;  weakness,  folding  or  prolapsing  of  the  rectal 
walls;  whether  the  grasp  of  the  external  sphincter  is  normal;  enlargement 
of  the  prostate  gland  in  the  male;  protrusion  of  the  cervix  or  fundus  of  the 
uterus  against  the  rectum  in  the  female;  the  presence  of  tumor  or  other 
growth;  haemorrhoids,  protruding  or  internal. 

The  prostate  gland  lies  below  the  anterior  wall  of  the  rectum  and  is  felt 
in  that  position  about  one  and  one-half  inches  from  the  anus.  Either  lat- 
eral lobe,  or  the  central  lobe  may  be  enlarged.  In  the  latter  case,  stricture 
of  the  urethra  is  threatened,  as  the  gland  surrounds  its  first  position. 

Treatment: — In  prolapsed  and  weakened  walls  the  finger  should  smooth 
out  the  walls  and  press  them  upward  as  far  as  possible.  This  aids  reposi- 
tion, tones  nerve  and  blood  force,  and  helps  to  establish  normal  tone  to  the 
muscular  walls. 

A  weakened  sphincter  is  much  stimulated  by  the  simple  insertion  of 
the  finger.  It  may  be  dilated  by  introducing  two  or  three  fingers  held  in 
wedge-shape,  spreading  them  apart  upon  withdrawal. 

For  an  enlarged  prostate  gland,  the  finger  makes  pressure  upon  it  and 
is  swept  laterally  over  it  to  aid  in  freeing  the  blood-flow  from  it.  Care  must 
be  taken  not  to  irritate  it. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  45 

In  ha:?morrhoicis,  all  the  surrounding  tissues  are  gently  manipulated  for 
relaxation  and  to  remo\e  interference  with  free  circulation,  after  which  pres 
sure  is  made  directly  upon  the  distended  vessels  to   empty  them    of    blood, 
and  to  gently  force  them  back  into  place  if  external. 

Rectal  treatments  should  not  usually  be  given  oftener  than  once  a 
week  or  ten  days.  Great  care  should  always  be  exercised  to  cause  as  little 
irritation  as  may  be.  As  a  rule  these  treatments  are  but  secondary  to  the 
removal  of  pelvic  or  spinal  lesion. 

E. — Osteopathic  Work  per  \'aginam. 

This  examination  is  made  with  the  index  finger  for  the  same  reasons  as 
in  the  case  of  rectal  treatment.  The  same  precautions  as  to  cleanliness,  etc., 
should  be  obser\'ed. 

As  a  rule  local  treatment  is  secondar}-  to  that  done  upon  spinal  or  pel- 
vic lesion,  which  is  usuall\'  the  real  cause  of  those  conditions  which  require 
local  treatment. 

It  is  proposed  here  to  re\iew  this  subject  onl}-  in  a  general  wa\",  giving 
the  main  points  in  connection  with  the  examination  and  treatment  of  this 
region  as  a  part  of  the  bod\',  leaving  detailed  consideration  to  the  portions 
of  the  course  dealing  specially  with  the  specific  diseases  of  these  organs. 

I.  Local  Examination: — The  patient  lies  on  her  back  or  on  her  side. 
In  the  latter  case  the  practitioner  stands  behind.  The  index  finger  anointed 
with  vaseline  is  introduced,  passing  from  the  region  of  the  fourchette  for- 
ward. The  guiding  hand  is  placed  upon  the  abdomen,  and  by  deep  pres- 
sure may  aid  in  locating  the  organ  and  in  diagnosing  its  position.  External 
pressure  over  the  region  of  the  broad  ligaments  will  sometimes  re\"eal 
tenderness  in  them  in  cases  of  prolapsus  uteri.  In  case  the  tenderness  is 
unilateral  it  is  usually  in  the  ligament  suffering  from  the  most  tension  be- 
cause of  the  organ  having  fallen  toward  the  opposite  side. 

The  examining  finger  should  first  note  the  condition  of  the  vaginal zaalls, 
which  ma\'  be  weak  and  flabby,  or  prolapsed  and  contorted  b)'  the  malpo- 
sition of  the  uterus.  The  presence  of  cnlaigement  or  tumor  of  iurrounding 
organs  is  to  be  noticed.  At  the  upper  extremity  of  the  vaginal  canal  is  felt 
the  cervix  protruding  into  the  canal. 

The  external  os  ute?i  opens  transversely  at  the  lower  end  of  the  cervix. 
In  women  who  have  borne  children  the  external  os  inclines  to  be  circular, 
but  by  careful  examination  the  transverse  axis  ma>-  be  distinguished.  This 
is  made  more  certain  by  the  shape  of  the  cervix,  which  is  somewhat  flat- 
tened antero-posteriorly.  By  these  two  points,  the  transverseness  of  the  os 
and  the  position  of  the  cervix,  the  main  diagnosis  of  the  position  of  the 
uterus  is  made.  If  the  transverse  os  (or  the  longer  transverse  diameter  of 
the  cervix)  has  assumed  an  oblique  direction  in  the  pelvis,  it  indicates  a 
corresponding  turn  in  the  position  of  the  organ.     This  turning  to    one  side 


46  PRACTICE  AKD  APPLIED  THERAPEUTICS  OF  OSTEOHATHY, 

is  usually  combined  with  the  prolapsus  of    the  ^organ    in    one    direction    or 
another. 

If  the  cervix  points  forward  and  upward,  the  fundus  has  gone  down  and 
back,  and  may  be  against  the  rectum.  In  such  case  the  fundus  is  often  felt 
through  the  posterior  vaginal  wall.  Or  the  uterus  may  have  turned  in  fall- 
ing backward,  so  that  the  fundus  lies  down  toward  either  sacro-iHac  region. 
If  the  cervix  points  backward  and  upward,  it  indicates  that  the  cervix  has 
descended  anteriorly  upon  the  bladder.  It  may  often  be  felt  through  the 
anterios  vaginal  wall.  There  are  all  degrees^  of  prolapsus,  some  ma)  be  so 
slight  that  the  cervix  and  fundus  have  deviated  but  little  from  normal  posi- 
tion. By  noting  the  direction  of  theos,  the  direction  of  the  cervix,  and  (if 
possible)  the  position  of  the  fundus,  no  difficulty  is  usually  experienced  in 
discovering  the  form  of  prolaosus  from  which  the  patient  is  suffering. 

The  different  forms  of  flexion  are  more  difficult,  but  may  be  made  out 
by  the  relative  position  of  the  cervix  and  fundus.  For  example,  if  the  cer- 
vix remains  near  normal  position  while  the  fundus  is  found  backward,  retro- 
flexion is  diagnosed. 

II.  Local  Treatment: — The  patient  ma\-  lie  upon  the  back,  upon  the 
side,  or  kneel  upon  the  table  with  the  trunk  inclined  forward  and  the  chest 
touching  the  table. 

In  the  first  or  second  position,  the  patient  may,  while  the  operating 
finger  still  supports  the  organ,  slip  off  of  the  table  and  stand  upon  the  fioor, 
bending  forward  to  remove  the  weight  of  the  viscera  above,  while  the  finger 
presses  the  organ  back  toward  its  position.  In  any  esse,  the  idea  of  the 
treatment  is  to  so  manipulate  the  cervix,  by  pre >sure  or  traction,  as  to  cause 
the  cervix,  thus  the  fundus,  to  assume  its  natural  position. 

The  knee-chest  position  is  the  best  for  the  treatment  of  such  cases.  It 
allows  the  force  of  gravitation  to  act  to  draw  the  intestines  from  the  pelvis» 
which  permits  easy  reposition  of  the  organ.  At  the  same  time  the  vagina 
ma\  be  dilated,  and  atmospheric  pressure  aids  materially  in  forcing  the  ut- 
erus high  up  to  its  position.  Moreover,  when  the  patient  has  changed  her 
position  first  onto  the  side,  then  onto  the  feet,  the  intestines  fall  back  around 
the  organ  and  help  support  it. 

The  treatment  described  in  Chap  VIII,  div.  Ill,  may  be  applied  to  the 
external  treatment  of  pelvic  disorders. 

The  /t'«;/d^//^rt/;/^«/'jr  of  the  uterus  may  be  located  and  may  be  stimu- 
lated by  pressure  upon  the  upper  margin  of  the  pubic  arch,  about  a  half  an 
inch  externally  from  the  symphysis. 

Inspection  of  the  female  pcrineuvi  sometimes  reveals  a  downward 
bulging  of  it  in  place  of  the  natural  slight  arch  of  the  healthy  perineum. 
Such  a  condition  indicates  prolupsus  of  the  pelvic  viscera. 

In  child-birth,  strain  upon  the  perineum  may  be  relieved  by  grasping 
both  tubers  ischii  from  below  with  one  hand,  while  the  other  hand  presses 
the  tissues  over  the  pubic  crest  in  front  down  toward  the  perineum.  The 
first  hand,  meanwhile  is  tending  to  spring  the  tuberosities  toward  each 
other. 


CHAPTER  X. 
The  Limbs. 

I.  Shouldek  Dislocations.  The  head  of  the  humerus  may  be  dislo- 
cated downward  into  the  axilla;  forward  beneath  the  clavicle;  backward 
upon  the  scapula;  or  forward  beneath  the  coracoid  process. 

With  the  patient  sitting,  and  the  trunk  fixed  by  an  assistant,  the  prac- 
titioner stands  at  the  side,  rests  his  foot  upon  the  stool  and  places  his  knee 
in  the  patient's  axilla.  Traction  is  now  made  directl)'  downward  upon  the 
arm,  overcoming  the  tension  of  the  muscles  and  drawing  the  head  back  into 
the  glenoid  fossa.     This  treatment  will  answer  for  any  of    the    dislocations. 

The  same  object  may  be  accomplished  by  placing  the  patient  upon  his 
back,  while  the  practitioner  stands  at  the  side,  places  his  stockinged  foot 
in  the  axilla,  and  exerts  strong  traction  upon  the  arm. 

II.  Elbow  Dislocations.  The  radius  and  ulna  may  be  both  displaced 
backward,  externally  or  internally:  the  ulna  backward;  the  radius  forward 
or  backward. 

The  patient  sits,  and  the  practitioner  satnds  at  the  side  with  his  foot 
resting  upon  the  stool  and  his  knee  in  the  bend  of  the  elbow.  The  upper 
arm  is  fixed  and  traction  is  made  strongl)-  upon  the  forearm.  This  will  be 
sufficient  for  the  first  four  dislocations.  When  the  radius  is  backward, 
direct  pressure  upon  it  is  sufficient  to  reduce  it.  When  the  radius  is  for- 
ward the  hand  is  supinated.  it  is  bent  upon  the  wrist  away  from  the  radius, 
thus  bringing  traction  upon  it.  while  pressure  is  made  upon  the  head  of  the 
bone  abo\  e. 

III.  Wrist  Dislocations.  The  radius  and  ulna  may  both  be  forward, 
backward,  or  outward.     Simple  traction  will  reduce  them. 

I\'.  Radio  ULNAR  Dislocations.  The  radius  is  regarded  as  the  fixed 
bone,  the  ulna  being  displaced  forward  or  backward.  Direct  pressure  upon 
it  will  force  it  to  its   place. 

V.  Carpo-Metacarpal  dislocations  are  more  frequent  in  case  of  the 
thumb.      Direct  pressure  will  reduce  them. 

\T.      Dislocations  of  carpal  bones  are  easily  reduced  b\-  pressure. 

VII.  Metacakpo  Phalangeal  dislocations  in  case  of  the  thumb  are 
most  frequent.  For  the  backward  one.  continued  strong  hyper  extension, 
followed  b\-  flexion  are  used.  If  this  treatment  does  not  succeed,  the  meta- 
carpal is  rotated  and  pressure  is  made  upon  its  head.  In  the  fot~>.'ard  dis- 
placement traction  and  pressure  are  employed,  or  strong  flexion  is  followed 
by  direct  pressure. 

In  case  of  the  fingers,  simple  traction  and  pressure  are  sufficient,  as  is 
also  the  case  in  Phalangeal  dislocations. 

These  remarks  apply  to  all  cases  of  recent  dislocation  as  described.  It 
more  often  comes  within  the  Osteopath's  province  to  work  upon  old  dislo- 
cations, so  frequentl)-  given  over  as  incurable.    As  far  as  possible  he  applies 


48  PRACTICE  AND  Alll.lED  THEKAPEUTJCS  OF  OSTEOPATHV. 

the  usual  mot  ons  for  the  reduction  of  them,  but  prepares  the  joint  for  re- 
duction by  a  course  of  treatment  directed  to  relaxing  surrounding  muscles 
etc.;  to  restoration  of  free  circulation  about  the  part  and  the  upbuilding  of 
the  tissues.  Often  a  persistent  course  of  treatment  restores  a  bone  to  posi- 
tion when  it  had  been  given  up  as  hopeless.  These  remarks  apply  espec- 
ially to  old  dislocations  of  the  hip  joint. 

General  Treatment  fok  the  Upper  Limb.  In  treatment  for  various 
conditions  the  arm  is  manipulated  in  special  ways. 

I.  The  shoxilder-joint  ma\-  be  sprung  to  allow  of  free  blood-flow  and  to 
remove  tension  in  the  ligaments.  The  clenched  hand  is  placed  in  the  axilla, 
care  being  taken  not  to  press  the  knuckles  against  the  axillary  hmphatics. 
or  against  the  nerves  and  vessels  on  the  inner  side  of  the  arm.  It  is  best  to 
turn  the  hand  sidewise.  The  patient's  arm  is  now  forced  against  his  side, 
springing  the  head  of  the  humerus  outward. 

II.  The  clboiv  may  be  sprung  by  flexing  the  fore  arm  o\er  the  hand 
placed  upon  the  arm  just  abo\e  the  bend  of  the  elbow.  Or  the  fore-arm 
may  be  flexed  to  a  -light  angle,  and  the  treating  hands  draw  it  away  from 
the  lower  end  of  the  humerus.  The\'  ma)-  follow  along  down  the  fore-arm, 
working  deepl)-  between  radius  and  ulna  to  relax  the  interosseous  tissues. 

III.  The  branches  of  the  brachial  plexus  and  the  axillary  artery  ma>- be 
impinged  against  the  inner  side  of  the  humerus  just  below  the  axilla. 
Transverse  friction  reaches  all  these  nerves  and  may  be  used  to  tone   them. 

1\'.  Catching  of  the  anterior  fibres  of  the  deltoid  muscle  under  the 
coracoid  process,  and  attendant  slight  forward  luxation  of  the  head  of  the  hii- 
tncrus  may  be  remedied  by  grasping  the  arm  just  above  the  elbow  and 
drawing  it  directly  back  and  up  to  the  level  of  the  shoulder.  Now  the  arm 
is  carried  forward  at  the  same  level,  and  the  movement  is  finished  with  a 
slight  upward  turn. 

\'.  The  biceps  muscle  and  its  lo7is;  head  may  be  strongly  stretched  by 
drawing  the  extended  fore-arm  directly  backward  and  upward. 

General  Treaiment  for  thk  Lower  Li.mb. 

I.  Strong  flexion  of  the  thigh  on  the  thorax  and  the  leg  upon  the 
thigh  stretches  the  quadriceps  extensor  muscle. 

II.  H)  per-extension  of  the  thigh  stretches  the  anterior  structures,  in- 
cluding the  femoral  \essels  and  anterior  crural   ner\e. 

III.  H\per-extension  of  the  foot  stretches  the  anterior  muscles  of  the 
leg.     Strong  flexion  of  the  foot  stretches  the  calf  muscles. 

IV.  Adductor  muscles  of  the  thigh  are  stretched  by  forced  abduction. 
The  patient  lies  upon  his  back,  the  practitioner  presses  against  one  leg 
which  remains  upon  the  table,  at  the  same  time  keeping  the  other  leg 
straight  and  abducting  it  to  the  extreme.  He  ma\'  stand  between  the  legs. 
The  same  object  is  accomplished  by  flexion  combined  with  external  cir- 
cumduction. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  49 

V.  The  muscles  of  external  rotation  for  the  thigh  are  stretched  by 
flexion  combined  with  internal  circumduction. 

VI.  The  extensor  muscles  of  the  thi^h  are  stretched  by  raising  the 
straightened  limb  to  or  beyond  right  angles  with  the  trunk.  This  may  be 
accomplished  with  the  patient  on  his  back.  The  limb,  still  straight,  may 
be  supported  at  right  angles  while  the  foot  is  strongly  flexed  on  the  leg. 
TWx'i  stretches  the  sciatic  nerve.  This  nerve  is  also  stretched  by  motion  I. 
Motion  V.  stretches  the  pyriformis,  gemeili,  and  obturator  muscles,  and  aids 
in  removing  irritation  from  the  sciatic  nerve.  All  of  the  motions  for 
stretching  this  nerve  act   partly  through  relaxation  of  tissues  about  it. 

VII.  Pressure  at  the  mid-line  of  Scarpa's  triangle,  about  two  inches  be- 
low the  middle  of  Poupart's  ligament,  impinges  the  femoral  vessels  and  the 
anterior  crural  nerve. 

VIII.  The  popliteal  ner\e  and  ves^^els  are  reached  at  the  popliteal 
space.  The  patient  lies  upon  his  back.  The  limb  is  drawn  over  the  edge 
of  the  table  and  the  foot  is  supported  between  the  practitioner's  knees. 
Manipulation  is  now  made  deeply  just  below  the  knee  behind. 

IX.  Forced  flexion,  extension,  inversion  and  eversion  of  the  foot  may 
be  made  for  the  purpose  of  relaxing  all  the  ligaments  of  the  ankle. 

All  of  the  treatments  described  for  the  upper  and  lower  limbs  are 
given  in  a  general  way.  The\'  ma}'  be  used  in  the  treatment  of  specific 
cases  of  disease  in  \arious  wa)  s.  One  should  not  forget  that  the\'  are  used 
as  aids  in  the  reduction  of  special  lesions  or  as  secondary  thereto. 

X.  In  treatment  upon  \\\q  feet  one  notes  the  two  natural  arches,  the 
transverse  and  the  longitudual.  Springing  these  arches  by  pressure  upon 
the  arch  above  and  traction  at  the  same  time  upon  the  ends,  aids  in  relax- 
ing ligaments  and  other  tissues,  reducing  bony  luxations,  removing  press- 
ure from  nerves  and  blood-\'essels.  The  treatment  ma}'  be  made  more 
effective  by  springing  the  arch  both  ways,  i.  e.,  first  applying  pressure  such 
as  to  increase  the  concavit)'  of  the  arch,  then  to  lessen  it. 

XI.  In  treatment  for  the  tecs  the  blood-vessels,  which  lie  upon  the 
sides,  are  stretched,  and  the  tissues  about  them  relaxed,  by  bending  them 
laterally.  The  lateral  movements,  combined  with  extension  flexion,  and 
traciion,  free  the  joint  and  its  nerves,  vessels,  and  tissues. 

XII.  The  saphenous  opening  an  inch  and  a  half  below  the  inner  end  of 
Pouparts'  ligament,  is  often  in  an  occluded  condition  such  as  to  seriously 
impede  the  flow  from  the  long  femoral  vein.  The  muscles  and  tissues  about 
it  ma)'  be  stretched  by  external  rotation  of  the  flexed  knee.  F'oUowing 
this  movement  b)-  internal  rotation  of  the  extended  limb  relaxes  the  tissues 
still  further  and  allows  of  direct  manipulation  upon  the  opening. 

XIII.  With  the  patient  lying  upon  the  back  one  notes  the  angle  of 
deviation  of  the  toes,  i.  e.,  the  angle  between  the  feet.  If  one  foot  rotates 
outward   too    much  or  too  little,  it  re\'eals  tenseness  or  laxness  of  the  rotat- 


50  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

tors  of  the  thigh,  and  may  lead  one  to  the  discox'cry  of  abnormal   peKic  or 
hip  conditions. 

Concerning  di'/.j/(7r«/'w/.?  of  the  lower  limbs,  one  must  bear  in  mind  that 
many  of  the  cases  presented  to  the  Osteopath  are  old  dislocations.  The 
success  of  Osteopath)'  in  the  reduction  of  such  has  been  marked.  Again, 
many  cases  are  met  with  in  which  gross  dislocation  is  not  present,  but  a 
slight  luxation,  or  "slip,"  of  a  joint  has  occurred  and  has  been  overlooked 
by  other  practitioners.  The  number  of  cases  in  which  such  a  sight  displace- 
ment in  the  hip-joint  has  caused  apparent  disease  in  the  knee,  sciatica, 
lameness,  etc.,  is  remarkable.  The  fact  that  these  things  are  commonly,  or 
at  least  frequently,  not  discoxered  by  others  than  Osteopaths  indicates 
something  of  the  need  and  importance  of  osteopathic  methods.  The  prac- 
titioner must  bear  in  mind  the  probability  of  such  occurrences,  and  must  be 
upon  his  guard  to  disco\-er  them.  As  a  rule,  in  all  old  dislocations  and 
chronic  sublu.xatious  of  this  nature,  the  reall\  important  osteopathic  work 
is  the  preparation  of  the  parts  for  the  restoration  of  normal  relations.  Re- 
laxation of  old  contractures  in  muscles,  softening  ligaments,  development 
of  atrophied  parts  through  the  upbuiltling  of  blood  and  nerve-suppl)-  are 
the  preliminary  steps  taken  by  general  osteopathic  methods  already  de- 
scribed. In  case  of  such  luxations,  gross  dislocations  excepted,  the  stand- 
point of  the  Osteopath  in  diagnosis  is  a  new  one.  This  teaching  leads  him 
to  look  for  such  causes  of  disease,  which  are  meaningless  toother  methods 
of  practice. 

I.  Dislocations  OF  THE  Ankle.  The  displacement  may  be  of  both 
leg  bones  forward,  backward,  inward  or  outward.  In  either  case,  the  patient 
lies  upon  his  back;  the  leg  is  elevated  to  a  right  angle  and  fixed  by  an 
assistant,  and  strong  traction  is  made  upon  the  foot.  The  muscles  draw  the 
ankle  into  place. 

II.  Dislocations  of  the  Knee.  The  leg  may  be  forward,  backward, 
inward  or  outward.     Strong  traction  restores  it  to  place. 

In  cases  of  slight  back  vard  luxation,  short  of  dislocation,  a  good 
method  is  to  have  the  patient  lie  on  his  back,  hang  th*^  leg,  btnit  at  the  knee, 
over  the  edge  of  the  table,  while  the  foot  is  supported  between  the  practi- 
tioner's knees  and  his  hands  work  in  the  popliteal  region.  The  hamstring 
muscles  are  grased  b}'  the  two' hands  and  stretched  awa>'  laterall)-  from  the 
condyles  of  the  femur,  while  the  tibia  and  fibula  are  drawn  forward. 

III.  Dislocations  OF  THE  Hip.  In  such  cases,  the  head  of  the  bone 
ma\-  be  displaced  as  follows: 

(i)  Up  and  back  onto  the  dorsum  of  the  ilium,  shortening  the  limb 
and  turning  the  toes  inward. 

(2)  Down  and  back  onto  or  near  the  sciatic  notch,  somewhat  shorten- 
ing the  limb,  and  turning  the  toes  inward. 

(3)  P'orward  and  down  onto  or  near  the  obturator    foramen    (th)roid 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  5I 

dislocation),  in  which  the  knee  is  flexed,  the  toe  points  to  the  ground  and 
rotates  inward  or  outward. 

(4)  Forward  and  up  onto  the  pubic  crest.  The  toe  invariably  turns 
out. 

In  (2),  as  the  patient  sits  up  from  a  lying  posture,  the  limb  shortens;  in 
(3)  and  (4)  it  lengthens. 

In  the  tTeahncnt  of  such  conditions,  fresh  dislocations  are  set  at  once, 
but  as  in  our  practice  many  old  dislocations  are  presented,  the  success  of 
the  treatment  lies  largely  in  knowing  how  to  thoroughly  prepare  parts  for 
adjustment  as  above  stated.  Much  lies  in  our  way  of  regarding  disease,  for 
even  gross  dislocations  are  often  overlook.  These,  and  the  many  luxations 
of  lesser  degree  found  in  osteopathic  diagnosis,  could  scarcely  be  over- 
look in  our  method  of  minutely  scrutinizing  the  mechanical  relations  of  all 
parts  in  examination  of  acase. 

In  (i)  the  knee  in  flexed  and  rotated  a  little  inward  to  disengage  the 
head  of  the  femur,  then,  while  pressure  is  made  to  force  the  head  toward 
the  acetabulum,  the  flexed  knee  is  rotated  well  outward  and  extended. 
This  draws  the  head  into  the  acetabulum.  The  patient  is  lying  on  his  back. 

In  (2)  the  manoeuver  is  the  same,  except  that  during  outward  rotation 
and  extension  the  trochanter  is  grasped  and  forced  forward  toward  the 
acetabulum.  In  the  inward  rotation  the  head  has  been  disengaged  from  the 
notch. 

In  (3)  the  flexed  knee  is  rotated  far  inward,  freeing  the  head  from  the 
obturator  foramen,  while  the  "Y"  ligament  acts  as  a  fulcrum.  As  the  in- 
ward relation  is  carried  downward  to  extension  the  head  is  forced  toward 
the  cotyloid  notch. 

In  (4)  the  patient  lies  upon  his  sound  side,  the  dislocated  thigh  is 
h)'per-extended  by  being  strongl}-  drawn  backward.  This  stretches  all  the 
muscles  about  the  head,  which,  after  slight  flexion  of  the  thigh,  is  lifted 
over  the  crest  of  the  pubes. 

In  (i)  and  (2)  the  patient  may  sit  upon  a  stool,  the  dislocated  limb  is 
crossed  above  the  other  knee,  the  pelvis  is  fixed  by  an  assistant,  the  tro- 
chanter is  pressed  by  one  hand  toward  the  acetabulum,  while  the  other 
hand  draws  the  limb  well  across  its  fellow  and  extends  it  to  place  the  foot 
on  the  floor. 

In  (i)  and  (2)  the  patient  may  stand  upon  one  foot,  supporting  his 
hands  upon  the  back  of  a  chair  ;  the  thigh  remains  straight,  and  the  knee 
is  flexed  to  a  right  angle;  the  ankle  is  supported  by  the  practitioner  who 
stands  at  the  side  of  and  behind  the  patient.  He  new  places  one  knee  upon 
the  popliteal  region,  allowing  the  weight  of  his  body  to  come  down  upon 
it.  This  forces  the  head  downward,  while  a  swing  of  the  ankle  outward  dis- 
engages it.  Now  a  swing  inward,  while  the  weight  is  still  applied,  brings 
the  head  into  the  acetabulum. 

These  various  motions  may  be  applied  to  subluxaitons  as  well  as  to 
gross  dislocations. 


^^/^,    '^^:>t^yKe^   (^/ChA^^^z.6-<^^ 


PART  II. 

DISEASES. 


NOTE. — //  is  the  intention  to  deal  here  only  with  the  osteopathic  views,  pHn-. 
ciples  and  methods  in  relation  to  the  various  diseases  considered.  Any  sta^idard 
medical  text  will  supply  the  reader  with  these  facts,  theories,  etc.,  ivhich  he  may  de-. 
sire  to  k7iow,  and  which  it  is  uniiecessary  to  repriiit  here. 


ASTHMA. 

Definition:  Asthma  is  a  disease  of  the  bronchial  tubes  characterized 
by  dyspnea.  It  is  spasmodic  in  nature,  the  air  tubes  being  narrowed  by 
spasm  of  their  muscularfibers  or  b>  swelling  of  the  mucous  membrane  from 
hypermia. 

Cause: — This  disease  alwa\s  presents  definite  lesions,  muscular  and 
bony,  of  the  upper  dorsal  spine  and  of  the  thorax.  Secondary  lesions  usu- 
ally occur  in  the  cervical  region.  The  chief  bony  lesions  affect  the  ribs  from 
ike  second  to  the  sixth  on  the  right  side.  (A.  T.  Still.)  The  majority  of  cases 
show  lesions  of  this  region,  but  the\'  may  occur  higher  up  or  lower  down. 
Lesion  is  often  found  in  the  neck.  (A.  G.  Hildreth.)  The  sternal  ends  of 
the  ribs  and  the  costal  cartilages,  as  well  as  the  spinal  ends  of  the  ribs  may 
show  the  lesion.  Lesions  of  the  ribs  from  the  second  to  the  seventh  on 
either  side;  of  the  corresponding  dorsal  vertebrae;  of  the  anterior  and  pos- 
terior thoracic  muscles;  of  the  atlas,  axis  and  hyoid  bone,  and  of  the  cerx'i- 
cal  muscles  are  all  active  in  producing  the  disease. 

A  review  of  the  typical  cases,  reported  from  various  sources,  and  in 
which  cures  were  made  by  the  removal  of  the  specific  lesion,  shows  a  defi- 
nite area  in  which  such  causes  occur,  (i)  Luxation  of  first,  second  and 
third  left  ribs.  (2)  Fourth,  fifth  and  sixth  dorsal  vertebrae  anterior;  the 
corresponding  ribs  lowered.  Two  treatments  stopped  the  attacks,  and  pa- 
tient was  discharged  as  cured  after  three  weeks'  treatment.  (3)  Second 
dorsal  vertebra  lateral.  (4)  Fifth  right  rib  down  and  much  tenderness  of 
tissues  at  the  fifth  dorsal  vertebra.  This  case  was  of  thirty  years'  standing, 
and  is  reported  cured  by  two  weeks'  treatment.  (5)  The  scaleni,  mas- 
toid and  anterior  and  posterior  thoracic  muscles  very  tense.  (6)  Right 
fourth  and  fifth  ribs,  and  left  fifth  and  sixth  ribs  luxated.  This  case  was 
also  of  thirt)'  years'  standing.     One  month's  treatment  cured  it. 

(7)  The  axis  luxated  to  the  right,  cervical  muscles  contractured,  all 
the  ribs  depressed.  A  case  of  twenty  years'  standing,  cured  in  one  month. 
(8)  The  left  fifth  and  sixth  ribs  downward.  (9)  The  first  to  the  eighth 
ribs  on  both  sides  down;  spinal  muscles  of  the  same  region  contractured; 
luxation  of  the  atlas  and  axis;  depression  of  the  h)'oid  bone.  (10)  The 
second  dorsal  vertebra  luxated  laterally,  involving  the  corresponding  ribs; 
several  ribs  below  down,  (ii)  All  the  upper  dorsal  vertebrae  anterior, 
carrying  the  ribs  forward;  closeness  of  the  first  rib  to  the  clavicle. 

One  can  but  note  how  all  of  these  lesions  occur  in  those  regions  it  which 
it  is  claimed  the  cause  of  asthma  occurs.  No  other  school  of  practice  no- 
tices such  causes  of  this  disease.  Their  theories  are  various,  man}'  exciting 
causes  are  agreed  upon,  but  Anders  makes  the  statement  in  regard  to  the 
real  and  original  causes  that  they  are  of  an  unknown  nature. 

The  spinal  area  of  motion  is  given  by  Dr.  Still  as  extending  from  the 
fourth  to  the  sixth  dorsal    vertebra.     These  lesions  affect    this  area.     They 


56  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

cause  abnormal  motor  effects  both  in  arousing  spasmodic  conditions  of  the 
muscles  of  the  bronchial  walls,  and  in  the  vaso-motor  activity  that  produces 
the  hyperemia  of  the  mucous  membranes. 

There  are  good  anatomical  reasons  why  lesions  in  these  regions  affect 
the  lungs.  The  American  Text  Book  of  Phjsiology  states  that  stimulation 
of  the  vagus  in  the  neck  produces  constriction  of  the  pulmonary  vessels, 
while  stimulation  of  the  sympathetics  in  the  neck  causes  dilatation  of  them. 
Ouain's  anatomy  says  that  the  pneumogastrics  conve)-  motor  fibers  to  tlie 
unstriped  muscle  fibers  of  the  trachea,  bronchi,  and  their  subdivisions  in- 
the  lungs.  Vasoconstrictors  for  the  lungs  exist,  in  some  animals,  in  the 
second  to  the  seventh  spinal  nerves.  (Quain.)  The  anterior  pulmonary 
plexus  is  composed  of  the  pneumogastrics  and  the  sympathetics;  the  pos- 
terior, of  the  pnemogastrics  and  branches  from  the  second,  third,  and  fourth 
'thoracic  sympathetic  ganglia.  These  regions  of  the  spine,  with  their  im- 
portant nerxe  connections  with  the  lungs,  are  naturall}'  investigated  by  the 
Osteopath  in  relation  to  asthma.  It  is  reasonable  that  obstruction  to  the 
nerves  here  should  cause  the  disease.  Anders  gives  a-nong  exciting  causes 
"irritating  lesions  of  the  medulla."  The  Osteopath  finds  in  lesions  of  atlas, 
axis  and  cervical  tissues  sufficient  cause  of  such  irritation  of  the  medulla  as 
well  as  of  the  pneumogastric,  through  their  s\mpathetic  and  spinal  nerve 
connections.  In  these  ways,  lesions  to  the  cervical,  dorsal  and  upper  thor- 
acic structures  act  as  obstructors  of  these  nerve  mechanisms  concerned  in 
asthma,  the  pneumogastric  ner\e,  pulmonary  plexuses,  sympathetic  and 
vaso-motors,  and  cause  the  disease. 

Exciting  Causes  of  the  paroxN'sm,  such  as  bronchitis;  the  inhalation  of 
irritants,  such  as  dust,  fog,  smoke,  chemical  vapors,  pollen  of  plants,  odors 
of  animals;  reflex  irritation  from  nose  or  stomach;  the  results  of  other  dis- 
eases, etc.,  would  not  act  to  cause  asthma  did  these  anatomical  lesions  not 
exist  1  hev"are  the  real  CTuse  of  the  condition;  existing  in  an  individual,, 
they  obstruct  the  vital  forces  of  the  bronchi  and  deteriorate  the  vitality  of 
their  tissues,  perhaps  gradually  during  a  term  of  years,  and  make  it  pos- 
sible for  these  various  exciting  causes  to  act. 

The  PROGNOSIS  is  good  under  osteopathic  treatment,  though  under  med- 
ical treatment^com;)aratively  few  cases  recover.  Very  many  cases,  a  large 
number  of  them  apparently  helpress,  have  been  cured.  The  fact  that  most 
of  these  cases  coming  under  osteopathic  treatment  are  of  long  standing  and 
have  usuall)'  tried  every  known  remed)'  seems  to  make  little  difference  in^ 
gaining  results  upon  them.  Some  cases  the  most  severe  and  longest  stand- 
ing yield  quickest. 

Examination  and^Treatment  are  carried  out  according  to  the  meth- 
ods describedjin  Part  I,  (Chapters  I.  II,  III,  IV,  \T,  VII.)  Any  of  the  les- 
ions that  may  affect  the  bon\-  parts  in  the  regions  mentioned  may  produce 
the  disease.  Displacements  of  ribs,  vertebrae,  etc.,  need  not  take  place  in 
a  particular  direction.     Rib  and  thoracic  vertebral  lesions  are  more  likely  to^ 


PRACTICE  AND  APPLIED  THERAPBUTICS  OF  OSTEOPATHY.  5^ 

act  as  causes.  Lesions  in  the  neck  alone  seem  quite  unlikely  to  cause  it. 
Those  of  the  fourth  and  fifth  ribs  upon  the  right  side  are  most  frequently 
the  cause.  It  is  unnecessary  to  name  the  various  probable  causes  of  the  an- 
atomical derangements  or  lesions  named,  as  that  subject  has  been  fully 
dealt  with  elsewhere,  as  well  as  the  theory  of  the  exact  waj-  in  which  such 
lesions  as  the  Osteopath  finds  act  to  cause  disease. 

Treatment  must  always  depend  for  its  success  upon  removing  the 
causative  lesion,  but  treatment  durins;  the  attack  must  look  more  particularly 
to  immediate  relief  of  the  patient,  for  as  a  rule  these  lesions  can  be  removed 
only  by  a  course  of  treatment.  At  this  time  great  relief  is  given  and  the 
spasm  usually  quieted  by  thorough  relaxation  of  the  spinal  muscles  (Chap. 
II,  div.  I.  p.  8),  followed  by  raising  of  all  the  ribs  (Chap.  VII)  and  clavicles 
to  allow  free  thoracic  and  lung  action,  and  by  relaxation  of  the  muscles  and 
other  soft  tissues  of  the  neck.     Loosen  the  clothing  about  the  neck. 

The  best  time  to  treat  for  removal  of  the  lesion  is  between  attacks,  it 
being  located  and  treated,  according  to  its  kind,  b}'  methods  alread}'  de- 
scribed. Attention  should  be  given  the  sternal  ends  and  cartilages  of  the 
ribs,  and  to  the  intercostal  tissues,  as  well  as  to  the  heads  of  the  ribs  and 
the  vertebrae.  The  scapular  muscles  should  be  relaxed  (pp.  ID,  li),  the 
clavicles  raised  (p  34),  the  tissues  of  the  neck  thoroughly  relaxed  (p  20), 
the  spinal  column  relaxed  (p.  8,  II;  p.  9,  III,  IV,  V),  and  the  ribs  raised  at 
their  angles.  If  the  patient  finds  it  difficult  to  take  a  full  breath  raising  or 
correcting  the  fifth  rib  will  sometimes  give  relief.  Pressure  upon  the  phre- 
nic ner\e  aids  the  work  by  relaxing  the  diaphragm,  which  is  sometimes  ele- 
vated (p.  16,  VIII.) 

Treatment  once  a  week  or  ten  days  is  often  enough  in  most  cases.  Fre- 
quent treatment  may  undo  the  results  accomplished  and  keep  up  constant 
irritation.  Many  severe  cases  have  been  cured  by  a  few  treatments  at  long 
intervals,  or  by  a  single  treatment. 

Under  this  course  of  treatment  the  patient  usually  feels  relief  at  once. 
As  a  rule  the  spasms  and  the  various  attendant  symptoms  terminate 
abruptly. 

Care  of  patient  should  include  the  wearing  of  loose  clothing,  living  out 
of  doors  in  pure  air  if  possible,  or  in  large,  well  ventilated  rooms.  The  di- 
et should  be  light  and  easily  digested  to  avoid  danger  of  stomach  reflexes, 
and  the  patient  should  avoid  dust  and  other  exciting  causes. 


PRACTICE  AND  APPLTED  THERAPEUTICS  OF  OSTEOPATHY.  59 


BRONCHITIS. 

Definition:  Bronchitis  is  an  acute  or  chronic  inflammation  of  the 
mucous  membrane  of  the  large  and  middle  sized  air  tubes.  It  is  attended 
by  increased  secretions  and  cough,  and  is  caused  by  a  vaso-motor  disturb- 
ance of  the  vessels  ot  those  membranes  due  to  specific  lesions  in  the  upper 
spinal,  anterior  and  posterior  thoracic,  and  cervical  regions.  These  lesions 
may  be  bon)'  displacements,  muscular  contractures,  ligamentous  derange- 
ment, etc. 

Cause:  These  various  specific  lesions  cause  the  condition  by  obstruct- 
ing peripheral  nerves  or  centers  connecting  with  the  vaso-motor  innervation 
of  the  bronchi.  They  usually  occur  high  up  in  the  thorax,  and  in  the  neck, 
in  close  relation  to  the  vaso-motor  areas  for  the  bronchi. 

Lesions  found  causing  bronchitis  are  as  follows:  (i)  Luxation  of 
atlas  and  axis,  depression  of  hyoid  bone,  lowering  of  upper  eight  ribs,  con- 
gestion of  spinal  muscles.  (2)  Third  cervical  vertebra  anterior,  muscular 
tension  from  the  second  to  the  sixth  dorsal  vertebra,  second  left  rib  much 
depressed.  (3)  Fourth  dorsal  vertebra  lateral.  (4)  Luxation  of  clavicle 
and  first  rib  anterior!}'.  (5)  Anterior  and  posterior  intercostal  spaces  as 
low  as  the  fourth  or  fifth  either  changed  by  misplacement  of  rib  or  the  seat 
of  irritation  to  the  intercostal  structures  by  contracture.  (6)  Lesion  to  the 
vagus  nerve  by  cervical  luxation  and  contracture,  also  luxation  of  the  four 
upper  dorsal  vertebrae.  (7)  Luxation  of  the  first,  second  and  third  ribs. 
(8)  Displacement  of  the  anterior  ends  of  the  first,  second  and  third  ribs, and 
derangement  of  these  cartilages.  (9)  Bilateral  contracture  of  cervical  and 
spinal  muscles  as  low  as  the  sixth  dorsal.  (10)  Second  to  fourth  dorsal 
vertebrae  lateral,  (ii)  Luxation  between  manubrium  and  gladiolus  of  the 
sternum. 

The  anatomical  relations  between  these  lesions  and  the  seat  of  the  dis- 
ease are  clear.  While  generall}-  located  higher  than  in  the  case  of  asthma, 
they  still  fall  within  the  vasomotor  area  to  the  lungs.  As  to  lesion  of  the 
atlas,  axis,  and  other  cervical  tissues,  in  relation  to  the  vagus  and  cervical 
sympathetics,  as  well  as  of  the  upper  dorsal  vertebrae,  ribs,  and  muscles  to 
the  \aso-motor  innervation  of  the  bronchi,  the  same  remarks  apply  as  in 
case  of  asthma,  q.  v.  Noting  from  the  above  lesions  that  they,  being  higher, 
are  more  concentrated  upon  the  vaso-motor  centers  of  the  bronchi,  (2nd,  3rd, 
4th  dorsal),  may  explain  in  part  the  reason  for  a  more  intense  vaso-motor 
effect  necessary  to  produce  the  inflammation  of  the  membranes.  Luxations 
of  the  clavicle  and  first  rib  anteriorly  are  anatomically  related  to  the  dis- 
ease as  causing  contracture  of  the  anterior  deep  cervical  tissu&s  and  thus 
obstructing  both  phrenic  and  pneumogastric  nerves,  concerned  in  innerva- 
tion of  the  lungs,  retarding  the  circulation  in  the  cervical  vessels,  and 
collaterally  obstructing  circulation  in  the  lungs.     The  general  dilatation  of 


60  PKACTICK  Av:i)  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

the  air  tubes,  often  seen  in  chronic  cases,  is  likely  caused  by  those  lesions 
especially  affecting  the  vagus,  which  innervates  the  involuntary  muscles 
regulating  the  calibre  of  the  bronchi.  Lessened  action  of  the  nerve  allows 
a  dilatation  of  the  tubes  through  loss  of  tonicity  of  those  muscle  fibres.  The 
same  explanation  probably  accounts  for  local  thinning  and  dilatation  of  the 
walls  of  the  tubes. 

Osier's  statement  that  the  cause  of  the  disease  is  probably  microbic  is 
a  confession  that  the  real  cause  is  not  known.  We  hold  the  true  cause  to 
be  anatomical  lesions  as  described.  The  fact  that  the  disease  is  often  a 
sequel  of  catching  cold  is  suggestive  from  an  osteopathic  view  point.  The 
contraction  of  muscles  and  tissues  from  exposure  ma)-  be  sufficient  lesion, 
or  may  produce  actual  bony  luxations  b)'  drawing  parts  out  of  place.  The 
further  fact  that  the  subjects  of  spinal  curvature  are  prone  to  the  disease  is 
a  confirmation  of  the  osteopathic  idea  of  making  bon)-  lesions  the  cause. 

The  PROGNOSIS  is  good  for  both  acute  and  chronic  cases.  Many  of  the 
latter  are  cured  in  a  comparatively  short  time,  varying  usually  from  one 
month  or  less  to  three  months.  In  the  former  the  first  treatment  gives 
great  relief,  and,  if  the  case  is  seen  early  enough,  may  abort  the  attack.  A 
few  treatments  usually  start  the  patient  well  on  the  way  to  recovery,  and  as 
a  rule  he  is  well  in  about  one  half  of  the  time  these  cases  usually  run,  which 
is  stated  to  be  two  or  two  and  a  half  weeks. 

In  the  TREATMENT  of  the  case  the  specific  lesions  should  be  at  once 
sought  and  treated.  Often  relief  can  be  given  only  in  this  way.  A  thor- 
ough treatment  should  be  given  the  spine,  thorax  and  neck  to  relax  all  con- 
tracted tissues.  Easing  of  the  tension  in  this  way  gives-great  relief,  as  the 
constriction  of  the  chest  and  neck  causes  much  of  thcAComfort  from  which 
the  patient  suffers.  This  is  aided  by  raising  all  the  ii  ■".  T-^  tnient  of  the 
neck  corrects  the  vagus  and  aids  in  dispelling  the  inflammation  by  its  par- 
ticipation in  the  vaso-motor  control.  In  the  same  way  relaxation  of  all  the 
tissues  of  the  dorsal  region  about  the  second,  third,  and  fourth  vertebrae 
particularly,  also  correction  of  these  vertebrae  themselves,  tends  to  the 
same  end.  The  clavicle  should  be  raised  and  the  first  rib  lowered  to  free 
irritation  to  the  phrenic,  vagus,  and  cervical  vessels.  Thorough  treatment 
of  the  spine  from  the  second  to  the  seventh  dorsal  \ertebra  (vaso-motor 
area)  aids  in  ecjualizing  bronchial  circulation,  the  work  on  the  left  side  as 
low  as  the  sixth  aiding  this  resuit  b)'  strengthening  the  pulse  beat.  This 
initial  portion  of  the  treatment  should  ^be  brisk  and  energetic  enough  to 
arouse  good  reaction.  It  relieves  the  patient  at  once  of  the  constriction, 
langor,  and  aching  pain  in  the  back.  It  frees  the  lungs  and  starts  perspira- 
tion. 

The  patient  should  be  laid  on  his  back  and  the  upper  anterior  ribs, 
cartilages  and  intercostal  structures  thoroughl)-  treated.  Strong  manipula- 
tion of  the  tissues  upon  the  anterior  chest  and  along  the  sternum  reddens 
them    and  acts  as  a  mustard  plaster  would.     These   treatments,  together 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  6l 

with  treatment  directly  along  the  trachea  in  the  neck  will  relieve  the  cough 
The  pain  along  the  sternum  is  relieved  by  raising  the  ribs  and  by  the  above 
treatments  along  the  anterior  chest.  The  fever  is  taken  down  by  the  equal- 
ization of  circulation  wrought  by  the  general  treatment,  and  by  pressure  in 
the  superior  cervical  region.  The  blood  flow  may  be  diverted  from  the 
bronchi  to  the  abdomen  by  a  slow,  deep,  inhibitive  treatment  over  it,  in- 
cluding pressure  over  the  solar  and  hypgastric  plexuses.  By  the  process 
of  raising  the  ribs  and  treating  the  spine  the  engorged  azygos  major  vein  is 
emptied.  The  restoration  of  free  thoracic  play  by  these  treatments  is  an 
important  consideration  in  the  eqalizing  of  the  circulation  throughout  the 
lungs. 

An  acute  case  should  be  treated  daily  at  least  once,  and  oftener  in  case 
of  need.  One  thorough  general  treatment  daily  may  be  sufficient  of  the 
kind.  Some  special  treatment  being  given  for  cough  or  fever  at  other 
times.  In  chronic  cases  the  treatment  should  be  given  two  or  three  times 
a  week.  In  case  of  local  or  general  dilatation  of  the  bronchi,  and  in  the 
thinning  of  the  walls,  close  attention  to  the  vagus  nerve  should  be  given  for 
reasons  already  explained. 

Good  care  should  be  taken  of  the  paient,  particularly  as  to  guarding 
against  exposure  which  may  lead  to  complications.  Treatment  should  be 
given  bowels  and  kidnej's  to  keep  them  active. 


HAY-FEVER. 

Definition:-— Hay-Fever  or  Autumnal  Catarrh,  is  a  disease  of  the  up- 
per respiratory  tract,  styled  by  some  writers  a  form  of  asthma.  It  is  caused 
by  specific  lesions  in  the  upper  dorsal,  thoracic  and  cervical  regions,  which 
deteriorate  the  vitality  of  the  membranes  of  this  tract  and  lay  them  liable 
to  the  effect  of  certain  irritants,  such  as  the  pollen  of  various  plants,  lead- 
ing to  an  inflammatory  or  catarrhal  condition. 

Lesions: — The  anatomical  causes  for  this  condition  are,  from  the  oste- 
opathic point  of  view,  held  to  be  derangements,  in  the  regions  mentioned, 
of  bones  or  other  tissues,  which  act  as  lesions  upon  the  motor,  vaso-motor 
and  sensory  innervation,  also  upon  the  blood-vessels  of  the  upper  respira- 
tory tract. 

In  one  case,  complicated  with  asthma  and  bronchitis,  the  scaleni,  ster- 
no-mastoid,  and  anterior  and  posterior  thoracic  muscles  were  contractured. 
In  another,  lesions  were  found  affecting  the  inferior  cervical  and  upper 
thoracic  regions. 

In  other  cases  lesions  were  found  as  follows:  Right  fifth  rib;  contract- 
ure of  muscles  from  the  ist  to  lOth  dorsal  vertebra,  with  ribs  in  this  region 
drawn  down;  second  cervical  vertebra  to  the  right  and  posterior;  second 
cervical  vertebra  right,  cervical  muscles  contractured,  upper   three    or    four 


62  PRACTICE  AND  ATTLIED  THERAPEUTICS  OF  OSTEOPATHY. 

dorsal  vertebra  to  the  rij^ht.  In  addition  to  these,  lesions  of  the  atlas,  of 
the  phrenic  nerve,  of  the  clavicles  and  upper  three  ribs  (especiall)- the  first) 
and  of  the  dorsal  vertebrae  as  far  as  the  fifth  are  all  found. 

The  fact  that  this  disease  is  often  found  complicated  with  asthma  and 
bronchitis  is  readil)'  explained  b)-  noting  that  lesions  for  all  of  these  con- 
ditions occur  at  the  same  area  of  the  spine.  In  all,  as  well,  vaso-motor 
lesion  seems  a  more  potent  cause  than  motor  lesion.  In  the  case  of  hay- 
fever,  as  with  the  other  two,  upper  cervical  lesion  is  less  important  than 
lower  cervical  lesion.  The  latter  kind,  with  those  affecting  the  first  few 
dorsal  vertebrae,  the  clavicle,  and  the  first  and  second  ribs,  are  always  ex- 
pected in  cases  of  hay-fever.  Purely  muscular  lesions  are  relati\ely  less 
important  than  other  kinds,  as  the)'  are  mere  likeh'  to  be  secondary  lesions. 
The  anatomical  rdation  of  lesion  to  disease  in  this  case  seems  clear. 
The  lesions  mentioned  affect  the  vagus,  cervical  sympathetic,  and  \aso- 
motor  ner\es  as  already  explained.  They  also  affect  the  fifth  cranial  nerve 
through  the  cervical  S)nipathetic,  including  the  superior  cervical  ganglion. 
This  is  the  nerve  which  causes  tne  swollen  and  painful  face,  the  running 
eyes  and  nose,  and  the  sneezing,  all  of  which  are  so  noticeable  in  hay-fever. 
The  fifth  nerve  and  the  vagus  are  intimately  related  in  function,  both 
of  the  respiratory  and  of  the  digestive  tract,  and  are  closel)-  connected  by 
the  floor  of  the  fourth  \entrical,  the  superior  cervical  ganglia,  and  the  cervi- 
cal sympathetic.  Lesions  to  the  vagusin  the  region  of  the  clavicle  and  first 
rib,  to  the  ssmpathetic  in  the  cervical  region,  and  in  the  upper  thoracic 
region  of  the  spine,  may  affect  one  or  both  of  these  nerves.  According  to 
Howell's  American  Text  Book  of  Ph)-siology,  vaso-dilator  fibres  for  the 
face  and  mouth  leave  the  cord  at  the  2d  to  5th  dorsal,  pass  up  the  cervical 
sympathetic  to  the  superior  cervical  ganglion,  thence  to  the  Gasserian  gang- 
lion of  the  fifth  and  to  the  regions  mentioned.  Thus  a  low  lesion,  affecting 
nerves  which  ascend  to  suppl)'  the  parts,  may  be  the  sufficient  cause  of  hay- 
fever.  At  the  same  time  the  close  association  of  this  disease  with  asthma 
is  shown,  since  the  vaso-motors  to  the  lungs  occupy  this  same  region  of  the 
upper  thoracic  spine- 
While  the  common  form  of  irritant  producing  the  attack  is  supposed  to 
be  dust  or  pollen  in  the  atmosphere,  the  fact  that  emotional  excitement,  a 
deflected  nasal  septum,  the  presence  of  a  nasal  polypus,  hypertrophied  mu- 
cous membranes,  etc.,  ma\-  produce  attacks,  shows  that  there  are  other 
causes,  some  of  them  anatomical,  accounting  for  an  irritable  nasal  mucous 
membrane  or  acting  as  an  irritant  upon  it.  It  is  as  reasonable  for  an  Osteo- 
path to  maintain  that  lesions  acting  as  obstructions  to  natural  nerve  and 
blood  supply  to  these  membranes,  weakens  them  and  lays  them  liable  to 
the  action  of  various  irritants,  thus  being  the  real  cause  of  the  disease. 
Immunit)-  from  attack  in  certain  climates  or  altitudes  is  but  alleviation.  The 
patient  has  gone  away  from  the  special  irritant  which  produces  the  attack 
in  him.     The  real  causes  of  the  disease  still  exist,  and   it    generally    returns 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  63 

upon  his  again  exposing  himself  to  the  same  irritant.  Although  a  patient 
is  more  liable  to  attacks  in  rural  districts,  more  cit}'  people  contract  the 
disease,  showing  that  a  locality  in  which  much  pollen  occurs  has  nothing  to 
do.  ^^;- 5^,  with  the  matter.  Osier  states  that  three  elements  are  necessary 
to  the  production  of  the  disease;  "a  nervous  constitution,  an  irritable  nasal 
mucosa,  and  the  stimulus."  Yet  nervous  people,  with  colds  or  catarrhal  in-, 
flammation  of  the  nasal  membranes,  may  be  with  impunity  in  districts  filled 
with  the  common  irritants  which  excite  attacks  in  ha)'-fe\-er  subjects.  Evi- 
dently some  further  etiological  factor  is  necessary,  and  is  found  in  the  speci- 
fic anatomical  abnormality  pointed  out  by  the  Osteopath,  the  removal 
of  which  has,  in  great  numbers  of  cases,  cured  the  disease.  The  most  se- 
vere cases  yield  quickh',  often,  upon  the  removal  of  the  specific  lesion.  The 
length  of  standing  of  the  case  seems  to  ha\e  but  little  relation  to  the  length 
of  time  necessary  to  cure.  A  case  of  fourteen  years'  standing  was  cured  in 
three  weeks;  one  of  twenty-four  years,  in  three  months;  one  of  five  years  in 
one  and  one  half  months.  This  rehersal  might  detail  great  numbers  of 
cases,  but  the  few  mentioned  illustrate  the  whole  matter.  In  view  of  these 
facts  it  seems  incontrovertible  that  the  specific  lesions  found  by  the  Osteo- 
path, and  held  b)'  him  to  be  the  cause  of  disease,  are  the  actual  causes  of  the 
disease. 

The  diagnosis  of  this  condition  is  easily  made  according  to  the  mani- 
festations of  the  disease  described  in  standard  medical  texts. 

The  PROGNOSIS,  under  osteopathic  treatment,  is  good.  A  large  per- 
centage of  the  cases  are  cured.  The  most  severe  and  oldest  cases  may  be 
safely  encouraged  to  take  the  treatment.  Of  medical  prognosis  in  hay- 
fever,  i\nders  says  that  permanent  cure  is  a  rare  event. 

The  Examination  AND  Treatment,  made  by  methods  already  given, 
(See  Part  I)  consist  in  the  location  and  removal  of  the  particular  anatomi- 
cal derangement  that  is  causing  the  condition.  The  removal  of  lesion  is 
the  first  consideration.  It  may,  occurring  in  the  fegion  described,  be  any 
one  of  the  mal-adjustments  of  tissue  considered  in  the  general  chapters  rela- 
tive to  the  examination  and  treatment  of  the  parts.  An  immediate  effort 
should  be  made  for  its  removal.  In  addition  special  treatment  is  given  to 
alleviate  the  condition.  K\\  the  upper  spinal,  thoracic  and  neck  muscles,  and 
deep  tissues  should  be  thoroughl\-  relaxed  for  freedom  of  circulation  and  to 
release  tension  upon  nerves.  The  ribs  and  clavicles,  apart  from  correction 
of  displacement,  should  be  raised.  Attention  should  be  given  to  releasing 
and  toning  the  vagus  nerve,  and  the  vaso-motor  nerves  from  the  2d  to  the 
7th  dorsal.  For  the  lachrymation,  itching  of  the  eyes,  swelling  and  pain  in 
the  face,  and  rhinorrhoea,  special  treatment  should  be  given  the  fifth  nerve. 
This  may  be  aided  by  deep  manipulation  and  pressure  in  the  sub-occipital 
fossae  for  the  superior  cervical  ganglion,  but  is  done  especially  b\'  relax- 
ation and  quiet,  deep  inhibitive  treatment  to  the  facial  branches  of  the  fifth 
nerve  (p.  23).  Treatment  is  given  along  the  sides  of  the  nose  (p.  23)  to  free 


64  PRACTICE   AND  AITLIED  THERAPEUTICS  OF  OSTEOPATHY. 

its  blood-vessels,  nerves,  and  to  reduce  the  swelling  and  irritation  in  the 
mucous  membranes.  Strong  pressure  is  made  with  the  palm  upon  the 
forehead  (p.  23)  to  open  the  nostrils.  Cervical  treatment,  inhibition  at  the 
superior  cervical  region,  and  opening  the  mouth  against  resistance  (II, 
Chap  I\'),  all  relieve  the  congested  circulation  about  the  head  and  face  and 
give  much  relief. 

For  the  sneezing  one  may  make  inhibition  of  the  phrenic  nerve  (p  16, 
VIII),  may  press  upon  the  palatine  branches  of  the  fifth  nerve  where  they 
run  over  the  hard  palate,  or  may  grasp  the  head  as  in  (4)  p.  21,  and  raise  it 
from  the  spine. 

Treatment  is  ordinarily  given  three  times  per  week.  The  patient 
should  be  kept  from  exposure  to  the  particular  initant  that  excites  his  at- 
tacks. 


PNEUMONIA. 

Definition:  Lobar  Pneumonia,  or  Lung  Fever  is  an  acute  inflamma- 
tion of  the  parenchyma  of  the  lungs  caused  by  specific  lesions;  bony,  mus- 
cular, or  ligamentous,  in  the  upper  spinal,  thoracic,  and  cervical  regions. 
In  other  forms  of  pneumonia  the  same  lesions  are  found.  Lobular  or 
Catarrhal  Pneumonia  is  an  inflammation  of  the  capillar)-  air  tubes,  which  ex- 
tends also  to  the  lung  tissue  proper.  Chronic  Interstitial  Pneumonia  is 
characterized  b)'  increase  of  the  interstitial  connecti\e  tissues. 

Causes:  Anatomical  lesion  in  the  form  of  displaced  bon}-  parts,  liga- 
ments, etc.,  and  of  contractured  or  tensed  muscles  and  other  soft  tissues 
are  found  affecting  the  spine  as  low  as  the  eighth  or  ninth  dorsal;  the  ribs 
in  the  corresponding  region,  but  more  generall\-  the  i.st,  2d,  3d,  4th  and 
5th;  the  intercostal  tissues,  including  nerves  and  vessels;  the  cervical  ver- 
tebrae and  tissues,  the  clavicle  and  first  rib.  More  specifically,  lesions  have 
been  found  affecting  the  2d  to  5th  dorsal  vertebrae;  contracture  of  inter- 
costal, cervical  and  spinal  muscles;  thoracic  muscles;  4th  and  5th  ribs;  8th 
and  9th  ribs;  the  vaso-motor  area,  the  2d  to  7th  dorsal;  neck  lesions  to  the 
vagi;  the  recurrent  laryngeal  nerves  at  the  1st  and  2d  ribs. 

The  anatomical  fclatio7is  of  such  lesions  to  the  lungs  have  been  explained. 
It  is  to  be  noted  that  the  neck  lesions  assume  greater  importance  in  these 
cases  than  in  asthama  or  bronchitis,  though  there  is  considerable  concen- 
tration of  lesion  about  the  portion  of  the  spine  in  which  is  located  the  most 
important  vasomotor  area  for  the  lungs,  the  region  as  low  as  the  fourth 
dorsal.  In  regard  to  neck  lesion,  important  considerations  are  pointed  out 
b>-  IMcConnell  in  regard  to  the  vagi  and  the  recurrent  laryngeal  nerves. 
Such  obstructions  to  the  vagi,  which  are  motor  nerves  to  the  lung,  cause  loss 
of  motor  power  in  them  and  favor  the  stasis  and  engorgement  present. 
Obstruction  to  the  recurrent  laryngeal  nerves  by  luxation  of  the  1st  and  2d 
rib,  or  by  engorgement  of  the  aorta  or  sub-clavian  artery  where  they  are  in 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  65 

relation  to  them,  causes  catarrhal  inflammation  of  the  air  tubes.  Lesions 
of  the  8th  and  9th  ribs,  affecting  fibres  to  the  lower  lobes  of  the  lungs,  are 
more  usual  in  cases  in  which  the  disease  occurs  in  the  lower  lung. 

The  fact  that  more  men  than  women  are  attacked  by  the  disease;  that 
a  debilitated  system  is  more  susceptible;  that  exposure,  winter  season,  and 
trauma  are  exciting  causes,  favors  the  theory  that  such  anatomical  lesions 
cause  the  disease.  The  result  may  be  caused  directly  by  them,  or  they  may 
make  the  anatomical  weak  points  that  lead  to  deterioration  of  the  lung  tis- 
sues and  lay  them  liable  to  invasion.  The  specific  microbes  found  in  such 
cases  could  not  live  and  grow  in  tissues  whose  vitality  had  not  been  weak- 
ened by  such  causes. 

If  the  case  be  seen  before  it  has*  passed  the  stage  of  engorgement,  the 
fever  may  be  gotten  under  control  at  once,  and  a  few  treatments  ma}'  abort 
the  case.  This  is  the  experience  of  our  practitioners,  although  Osier  says 
that  the  disease  can  neither  be  aborted  nor  cut  short  by  an}-  means  (medical) 
at  command.  The  means  at  the  Osteopath's  command  to  control  vaso- 
motor action  are  sufficient  to  relieve  the  engorgement.  In  the  stages  of 
red  and  gray  hepatization  it  is  natural  that  slower  results  must  be  expected 
as  the  treatment  has  more  work  to  accomplish.  Yet  vaso-motor  correction 
must  lessen' the  inflammatory  process,  allow  of  less  solidification,  and 
hasten  the  process  of  resolution. 

In  the  first  stage  there  is  better  opportunit}'  to  correct  the  specific  les- 
ion, as  the  patient's  strength  will  allow  of  such  treatment.  The  work  is  also 
aided  by  the  fact  that  the  alveoli  are  still  open,  and  lung  action,  stimulated 
by  treatment,  ma}-  become  a  valuable  aid  in  dispelling  the  engorgement.  In 
view  of  these  facts,  and  as  experience  shows,  every  symptom  of  the  case 
can  be  lessened  because  the  pathological  processes  are  modified.  Less 
poison  is  generated  and  the  patient's  general  condition  remains  better.  In 
one  case  the  treatment  was  applied  in  the  first  stage;  the  fever  was  under 
control  from  the  first  and  the  temperature  became  normal  in  three 
days.  In  another  it  disappeared  in  four  days;  in  another  in  five  days.  A 
case  in  which  the  temperature  was  104^2  degrees  when  first  seen  showed 
three  degrees  less  fever  the  next  morning.  It  had  been  treated  in  the  even- 
ing. In  a  case  in  which  the  temperature  was  103  degrees,  the  temperature, 
pulse,  and  respiration  became  normal  in  five  days.  It  is  true  that  cases 
vary  naturally,  yet  in  view  of  the  fact  that  Osier  states  that  the  fever  per- 
sists for  from  five  to  ten  days,  and  that  after  its  fastigium  is  reached  (usu- 
ally within  a  few  hours)  it  remains  remarkably  constant,  it  is  evident  that 
osteopathic  work  is  successful  to  a  marked  degree  in  bettering  the  case. 

The  diag7iosis  is  made  according  to  directions  given  in  standard  texts, 
and  by  the  location  of  specific  lesions. 

TViep}og7iosis  is  good  under  osteopathic  treatment. 

Examination  and  Treatment  for  the  location  and  removal  of  lesion  are 
made  according  to  methods  considered    in  Part  I.    In  beginning  the    treat- 


66  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

ment,  as  the  patient  finds  it  easy  to  lie  on  the  sound  side,  the  muscles  and 
deep  tissues  are  gently  but  thoroughly  relaxed  along  the  length  of  the  spine, 
particularl\'  upon  the  affected  side.  This  starts  vaso- motion  and  brings  a 
sense  of  relief  from  the  constriction  that  so  distresses  the  patient.  During 
this  treatment  upon  the  side,  treatment  is  gi\en  the  centers  for  bowels, 
kidneys,  and  superficial  fascia  (2d  dorsal  and  5th  lumbar)  to  rouse  them  to 
action  and  to  aid  in  the  elimination  of  poison  from  the  s\stem. 

This  initial  treatment  has  thus  prepared  for  the  more  specific  treatment 
for  the  fever,  itself  being  part  of  the  process.  The  next  step  consists  in 
turning  the  patient  gently  upon  his  back  and  thoroughly  relaxing  the  cervi- 
cal tissues,  the  tissues  behind  the  clavicle  and  first  rib,  raising  the  cla\icle 
and  depressing  the  first  rib,  after  relaxation  of  the  scaleni  muscles.  Treat- 
ment should  also  be  applied  to  the  course  of  the  vagi,  and  to  the  recurrent 
laryngeal  nerves  at  the  lower  inner  parts  of  the  sterno-mastoid  muscles.  In 
these  ways  motor  power  to  the  lungs  is  increased,  and  vaso-motion  is  cor- 
rected. The  treatment  for  fever  is  now  completed  by  stead)'  pressure  in 
the  sub-occipital  fossae  in  the  usual  way.  The  fever  is  not  likely  to  go 
down  at  once,  but  is  gradually  reduced  after  the  treatment,  for  some  hours. 
This  is  because  of  the  freedom  given  to  the  vaso-motors  in  the  course  of  the 
treatment,  and  to  the  gradual  change  now  being  wrought  in  the  patient's 
system  by  the  recuperated  forces. 

The  treatment  for  fever  ma}'  be  aided  b)-  the  deep  inhibiti\e  treatment 
to  the  abdomen,  before  described,  to  dilate  the  immense  abdominal  veins 
and  aid  in  calling  away  the  blood  from  the  engorged  lung. 

F'urther  treatment  is  given  the  lungs,  with  the  patient  on  the  back,  by 
gentl)'  elevating  the  ribs  from  the  second  to  the  seventh  on  both  sides.  This 
stimulates  the  vaso-motor  centers  to  the  lungs.  Elevation  of  all  the  ribs 
gives  much  relief  from  tension,  and  is  the  specific  method  of  relieving  the 
pain  in  the  side. 

Stimulation  of  the  accelerators  of  the  heart,  second  to  fifth  dorsal  on 
the  left  side,  aids  in  circulation  through  the  lungs,  and  stimulates  the  heart 
against  failure. 

For  the  cough,  the  treatment  should  be  close  and  deep  along  the 
trachea  from  the  larn\'x  to  the  root  of  the  neck,  also  relaxation  of  the  an- 
terior tissues  of  the  chest,  including  the  upper  intercostal  tissues.  The 
middle  and  inferior  cervical  regions  should  be  treated  for  the  lymphatics 
to  the  lungs.      (McConnell.) 

The  amount  and  strength  of  the  treatment  must  be  regulated  by  the 
patient's  condition.  Strong  treatments  are  not  allowed  on  account  of 
weakness.  The  general  treatment  should  be  given,  thoroughl\'  but  gently, 
once  a  da\'  at  least.  The  patient  should  be  seen  three  or  four  times  per  day, 
but  the  whole  treatment  outlined  need  not  be  given  each  time.  A  little 
treatment  for  the  fever,  to  release  tension  over  the  lungs,  to  relie\e  pain  in 
the  side,  etc  ,  ma}- be  enough  at  a  time. 

Hygienic  precautions,  the  use  of  hot  applications,  foot  baths,  rectal  in- 
jections, etc.,  maybe  employed  according  to  direction  of  the  standard  texts, 
as  necessary.  The  patient  should  have  plenty  of  water  to  drink,  and  should 
be  kept  upon  a  liquid  diet. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  67 

ACUTE  NASAL  CATARRH,  OR  CORYZA,  AND  COLDS. 

Definition: — Acute  Nasal  Catarrh  is  an  inflammation  of  the  nasal  mu- 
cous membranes,  accompanied  by  an  increased  secretion  of  mucous  and  by 
various  general  symptoms,  and  is  caused  by  specific  lesions,  in  the  cervical 
region  chiefly,  which  may  be  secondary  to  contractures  of  muscles  and 
soft  tissues  by  exposure.  After  repeated  attacks  the  disease  becomes 
chronic^  upon  account  of  the  confirmed  condition  of  the  lesions. 

A  "cold  in  the  head"  is  an  acute  attack  of  this  disease.  Yet  "colds'' 
may  settle  in  an)-  part  of  the  body,  as  a  rule,  in  "the  weakest  part,"  and  then 
probabl)'  assumes  the  form  of  congestion  instead  of  inflammation  as  in  the 
case  of  cor}'za.  Its  manifestations  are  various,  one  of  the  chief  ones  being 
the  disturbed  vaso-motor  reflexes  of  the  body.  These  weak  places  liable  to 
such  congestion  are  commouly  due  to  lesion  of  the  part,  which  acts  to  de- 
teriorate its  vitality  and  lessen  its  resistance  power. 

Causes: — The  specific  lesions  causing  such  disease  are,  as  a  rule,  high 
up  in  the  cervical  region,  effecting  especially  the  1st  to  3d  cervical  verte- 
brae, but  they  may  occur  as  low  as  the  sixth  dorsal.  One  of  the  chief 
forms  of  lesion  is  that  of  contracture  of  the  cer\'ical  muscles  and  deep  soft 
tissues.  These  contractures,  due  primaril)' to  exposure,  gradually  act  to 
warp,  or  draw,  the  cervical  vertebrae  and  intervertebral  discs  out  of  shape 
and  out  of  their  normal  anatomical  relations.  The  result  is  obstruction  to 
blood  and  nerve  supply,  causing  chronic  catarrh.  The  deeper  anatomical 
lesions  due  to  contracture,  and  to  other  causes  as  well,  produce  catarrh,  and 
not  some  other  disease,  because  of  affecting  certain  areas  of  nerve  connec- 
tions and  certain  centers.  Thus  lesion  of  the  upper  three  cervical  vertebrae 
act  upon  the  superior  cervical  ganglion,  in  ways  already  discussed,  and  dis- 
turb the  fifth  nerve  through  its  very  intimate  connections  with  the  ganglion 
in  question.  In  the  same  way,  lesion  to  the  inferior  cervical  or  upper  dor- 
sal bony  parts  may  affect  those  sympathetic  fibers  (or  the  area  of  the  cord 
giving  origin  to  them)  which  ascend  in  the  cervical  s}'mpathetic  chain,  fin- 
ally to  reach  the  fifth  nerve,  which  thus  supplies  secretory  fibers  to  the 
parts  in  question.  The  very  numerous  vaso  motor,  secretory  and  trophic 
fibers  for  all  parts  of  the  head  and  face;  for  salivary  glands,  eye,  ear,  tongue, 
face,  mouth,  etc.,  etc.,  passing  to  their  points  of  distribution  through  vari- 
ous of  the  cranial  nerves,  quite  generally  arise  in  the  upper  dorsal  and  cerv- 
ical cord,  having  also  numerous  connections  with  the  cervical  sympathetics. 
This  matter  has  been  fully  discussed  in  another  place.*  This  explains  the 
importanee  of  cervical  and  upper  dorsal  lesions.  Thus  lesions  low  down 
act  upon  the  ascending  fibers  of  nerve  suppl}'  and  affect  a  part  much  above, 
as  in  the  case  of  dorsal  lesion  here. 

The  fifth  nerve  bears  special  mention  in  these  cases  as  the  one  con- 
cerned in  the  headache,  lachrjmation,  sneezing,  secretion  of  mucous,  and 
inflammation  of  membranes.     This  nerve  is  also  in  part    concerned    in    the 


68  PRACTICE  AND  APPLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

loss  or  alteration  of  the  functions  of  taste  and  smell,  caused  by  pressure  of 
the  injected  membranes  upon  the  fine  nerve  terminals. 

The  Prognosis  is  good  for  all  forms  of  the  disease.  In  acute  cases  it  is 
particularly  so,  as  one  or  a  few  treatments  usuall}'  end  the  sjmptoms.  In 
chronic  catarrh  good  results  are  generally  easil\-  attained,  and  many  times 
a  cure  is  effected.  Unfavorable  climates  do  much  to  prevent  cure  as  the 
patient  is  constantly  e.xposed. 

The  Examination  and  Treatment  for  the  spccijic  lesion  is  made  accord- 
ing to  directions  in  Chaps.  I  to  VII.  The  specific  lesion  should  be  treated, 
and  removed  at  once  if  possible.  This  applies  to  both  acute  and  chronic 
cases.  In  acute  cases  one  of  the  first  steps  is  to  relax  all  the  upper  dorsal 
and  cervical  tissues.  A  thorough  spinal  treatment  tones  all  the  vaso-con- 
strictors  (2d  dorsal  to  2d  lumbar),  and  all  the  vaso-dilators  (all  along  the 
spine),  thus  aiding  to  equalize  circulation,  and  reduce  congestion  of  parts 
concerned. 

This  effect  is  aided  in  an  important  ua\'  by  raising  all  the  ribs,  and  par- 
ticularl)-  treating  all  the  2d  to  7-h  dorsal  region  on  both  sides,  in  this  way 
increasing  the  activities  of  heart  and  lungs.  The  anterior  thoracic  region  is 
treated  to  relax  tissues  and  replace  ribs;  the  clavicle  is  raised,  and  sepa- 
rated from  the  first  rib  to  rela.x  the  deep  anterior  cervical  tissues,  free  cir- 
culation through  the  carotid  arteries  and  juglar  veins,  and  to  free  the  pneu- 
mogastric  nerves.  All  the  cervical  muscles  are  thoroughly  relaxed,  the 
ligaments  released  by  deep  treatments,  and  the  vertebrae  of  the  whole 
region  manipulated.  This  frees  the  connections  of  the  sj'mpathetics,  the 
venous  flow  from  the  head,  and  tones  vaso-motion  in  the  affected  parts.  It 
is  an  important  step  in  remedying  the  congestion  of  the  parts  of  the  head. 
Inhibitive  treatment  should  be  given  the  superior  cer\-ical  ganglion  to  di- 
late blood-vessels  and  allow  the  congestion  to  be  swept  out.  The  superior 
and  inferior  h)oid  muscles  are  relaxed,  and  the  work  is  carried  down  along 
the  trachea  to  the  root  of  the  neck.  The  mouth  is  opened  against  resist- 
ance; the  tissues  beneath  the  angles  of  the  jaws  are  relaxed.  This  releases 
the  internal  jugular  veins,  stimulates  circulation  through  the  carotid  arter- 
ies, and  corrects  circulation  . 

Particular  attention  is  devoted  to  the  treatment  of  the  fifth  nerve  for 
reasons  already  given.  It  is  reached  at  points  upon  the  face  already  de- 
scribed, and  all  the  tissues  o\erthem  are  relaxed.  Treatment  of  this  nerve 
thus  directly  is  a  most  important  adjunct  to  that  given  its  sympathetic  con- 
nections. It  is  most  important  as  a  means  of  relieving  the  inflammation,  se- 
cretion, lachrymation,  and  stopping  of  the  nostrils.  Man'pulation  along 
the  sides  of  the  nose  frees  the  nasal  ducts  and  relieves  the  congestion; 
strong  pressure  upon  the  root  of  the  nose  and  upon  the  forehead  frees  the 
nostrils;  tapping  o\er  the  frontal  sinus  relieves  congestion  and  pain  in  it. 
The  headache  is  relieved  b}'  the  treatment  in  the  general  cer\ical,  superior 
cervical,  and  frontal  regions;  the  cough  is  relieved  by  the  treatment    along 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPAVHY.  69 

the  trachea;  the  chill}'  feeling  by  the  brisk  spinal  treatment.  The  soft  pal- 
ate may  be  treated  b)'  placing  the  finger  gently  upon  it  and  sweeping  it  lat- 
erally across.  This  treatment  may  be  carried  well  up  toward  the  opening 
of  the  eWstachian  tube.     The  congestion  of  these  parts  is  thus  relieved. 

The  lungs  must  be  kept  well  treated  to  prevent  the  cold  from  settling 
upon  them.  The  bowels  and  kidneys  are  treated  to  keep  their  action  free. 
The  treatment  about  the  lower  jaw  and  to  the  carotid  arteries  is  efficient  in 
reaching  the  eustachian  tube,  and  in  loosening  the  secretions  that  some- 
times occlude  it. 

In  chronic  cases  the  treatment  is  devoted  more  particularly  to  the  re- 
moval of  the  specific  lesion,  and  the  building  up  of  the  blood  supply  to  the 
nasal  membranes.  As  these  are  often  atrophied  or  hypertrophied  a  long 
course  of  treatment  is  generally  necessary  to  their  rehabliation.  The  prin- 
cipal treatment  is  directed  to  the  cervical  tissues,  where  chronic  contract- 
ure of  the  muscles  exists 

Daily  treatments  in  severe  acute  cases,  and  three  per  week  in  chronic 
cases,  are  usually  sufficient. 

The  patient  should  take  care  not  to  expose  himself,  but,  on  the  other 
hand,  should  not  keep  the  body  tender  and  susceptible  by  dressing  too 
warmly,  sleeping  under  too  many  covers,  or  living  in  overheated  quarters. 
One  may  contract  a  cold  by  going  suddenly  from  an  extremely  hot  to  a  very 
cold  atmosphere,  or  vice  versa. 

*See  "Principles  of  Osteopathy"  Lectures  XYI-XVIII. 


EPISTAXIS. 

Definition: — Epistaxis  is  the  term  used  to  designate  hemorrhage  from 
the  nose.  It  is  found  in  serious  form  in  some  people.  It  ma)'  be 
caused  by  accident,  as  in  fracture  of  the  skull,  or  by  local  irritation,  such  as 
picking  at  the  nose.  Cer\ical  lesion,  involving  the  atlas  and  the  muscles, 
has  been  noted.  Other  forms  of  cervical  lesion,  affecting  the  superior 
cervical  ganglion  or  the  cervical  s}'mpathetic  may  aid  in  causing  it. 

Treatment:—  Holding  of  the  facial  artery  where  it  crosses  the  inferior 
maxillary  bone,  and  the  nasal  arter)-  at  the  inner  canthus,  also  pressure  ap- 
plied to  the  carotid  arteries,  slow  the  blood  current  and  favor  the  formation 
of  a  clot.  In  some  cases,  friction  over  the  superior  cervical  region  has  been 
sufficient  to  arouse  sufficient  vasoconstriction  to  stop  the  flow.  The  case 
may  be  helped  by  raising  the  arms  high  above  the  head.  It  is  frequently 
difficult  to  stop  the  hemorrhage  at  the  time,  but  the  treatment  applied  to 
the  correction  of  the  lesion  and  to  the  freedom  of  circulation  through  the 
neck  will  stop  the  recurrence  of  the  hemorrhages.  In  severe  cases  it  may 
be  necessary  to  resort  to  plugging  of  the  posterior  iiares.  The  application 
of  ice  or  cold  water  to  the  superior  cervical  region,  and  the  use  of  hot  or 
cold  injections  into  the  nostrils  are  efficient  domesiic  remedies  for  the  con- 
dition. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


PLEURISY. 

Definition:  An  acute  inflammation  of  a  part  or  the  whole  of  one  or 
both  pleurae,  attended  b}'  cough  and  pain  in  the  side,  and  caused  by  lesions 
affecting  ribs,  thoracic  vertebrae  intercostal  and  spinal  muscles,  nerves,  etc. 

Causes:  The  important  lesions  in  these  cases  affect  the  ribs; 
cases  are  rare  in  which  lesions  of  this  kind  are  not  the  actual  cause 
of  the  disease.  Other  lesions  are  consequent  or  subsidiary  to  rib  lesions. 
They  ma\-  affect  the  ribs  of  either  side,  as  low  as  the  lOth  on  the  left  and 
the  9th  on  the  right,  marking  the  lower  limits  of  the  pleurae.  Secondary 
lesions  in  the  cervical  region,  affecting  pneumogastric,  phrenic,  or  s)mpa- 
thetic  nerves,  concerned  in  the  innervation  of  the  pleurae,  may  occur.  Le- 
sion of  the  clavicle  and  first  rib,  impeding  circulation  through  the  sub- 
clavian and  internal  mammary  arteries,  are  important.  The  cervical  lesions 
mentioned,  with  lesions  of  the  spinal  muscles  and  dorsal  vertebrae,  affect 
the  innervation,  composed  of  branches  from  the  pneumogastrics,  phrenics, 
sympathetics,  and  pulmonary  plexuses.  Important  derangement  of  circu- 
lation are  thus  caused  by  lesion  to  vaso-motors, aiding  the  process  of  inflam- 
mation, which  is  the  active  morbid  process  in  the  case.  The  drawing  of 
spinal  muscles,  luxations  of  vertebrae,  and  the  interference  with  spinal 
nerves  also  aid  the  causation  of  rib  lesions.  The  latter  sort  is  by  far  the 
most  efficient  one  in  causing  pleurisy  because  of  its  relation  to  the  inter- 
costal vessels  and  nerves.  These  nerses  and  \essels  all  together  total  a 
vast  area  of  blood  and  nerve  supply  to  the  pleurae,  especially  to  the  par- 
ietal portions.  The  nerves  carry  vaso-motor  and  secretorj-  fibres  to  the 
parts  supplied  by  them,  hence  to  the  pleurae.  Hilton  points  out  that  the 
nerves  innervating  the  linings  of  the  body  cavities  supply  also  the  skin  and 
muscles  of  the  walls  of  these  cavities.  This  is  well  instanced  in  the  case  of 
the  parietal  pleurae,  which  are  supplied  by  the  intercostal  nerves,  the}-  also 
supplying  the  intercostal  muscles  and  the  overlying  skin.  Such  being  the 
case,  lesion  by  displacement  of  ribs,  irritating  intercostal  nerves,  disturbs 
the  vaso-motor  and  secretory  processes  in  the  pleurae  supplied  by  the  same 
nerves.  Hilton  has  also  pointed  out  that  a  joint,  the  muscles  moving  the 
joint,  and  the  skin  overlying  these  muscles,  are  all  supplied  by  branches  of 
the  same  nerxes.  Hence  vertebral  lesion  and  lesions  affecting  the  relations 
of  the  heads  of  the  ribs  may  affect  the  nerves  through  their  articular 
branches.  In  this  way  spinal  lesion  might  be  the  origin  of  such  disease. 
But  further,  since  each  intercostal  nerve  is  connected  by  the  rami  commu- 
nicantes  with  the  sympathetic  system, lesion  of  these  nerves  affects  the  sym- 
pathetics. These  sympathetics  in  the  dorsal  region  contain  both  vaso-di- 
lator  and  vaso-constrictor  fibres;  the)-  enter  into  the  formation  of  the 
pulmonary  plexus,  which  in  part  innervates  the  pleura.  Hence  intercostal 
lesion  affects  vaso-motor  control  of  the  parietal  pleura  directl)',  and  of  the 
visceral  pleura  indirectly.     In  another  way  does  intercostal  lesion  act  to  set 


PRACTICE  AND  APPLIED  THERAPEUTICS  OE  OSTEOPATHY.  71 

up  the  inflammatory  process  of  pleurisy.  Lesions  of  the  clavicle,  derang- 
ing circulation  through  the  sub-clavian  and  internal  mammary  vessels,  and 
of  the  other  ribs,  directly  obstructing  the  intercostal  vessels,  and  indirectly 
deranging  the  circulation  through  related  vessels  to  the  'visceral  pleurae, 
(bronchial,  mediastinal,  and  diaphragmatic  vessels)  disturb  the  entire  cir- 
culation to  these  parts. 

In  these  ways  may  all  the  various  lesions  described  work  together  to 
produce  inflammation.  The  affected  area  is  larger  or  smaller  according  to 
the  nature  and  extent  of  the  lesions.  Lesion  of  a  single  rib  has  frec^uently 
been  found  responsible  for  an  acute  attack  of  pleuris)',  either  circumscribed 
and  limited  in  extent,  or  spreading  to  involve  cons'derable  areas.  The 
same  sort  of  lesion  may  produce  all  the  various  kinds  of  pleuris)'  described 
in  medical  texts. 

According  to  osteopathic  theor}%  the  bacteria  present  in  this  disease 
and  ascribed  by  some  writers  as  its  cause, could  not  live  and  propogate  their 
poisons  in  healthy  tissues.  The  presence  of  the  lesions  described  may 
weaken  the  tissues  and  allow  the  microbes  to  gain  a  foothold.  It  is  signi- 
ficant that  exposure  to  cold  and  wet,  and  mechanical  injuries  cause  the  dis- 
ease, as  the  Osteopath  looks  for  such  causes  to  produce  the  displacements 
and  other  lesions  to  which  he  traces  the  disease 

The  diagnosis  is  made  according  to  the  symptoms  and  physical  signs 
described  in  standard  medical  texts. 

The  PROGNOSIS  is  good.  Cases  generally  recover  without  difficulty. 
Often  all  the  pain  and  other  manifestations  disappear  at  once  upon  remo\-al 
of  lesion;  the  setting  of  a  rib. 

The  Examination  and  Treatment  for  the  specific  lesion  are  carried 
on  according  to  directions  given  for  the  examination  and  treatment  of  those 
regions.  This  lesion  should  be  removed  as  soon  as  possible,  and  at  once  if 
the  condition  of  the  patient  will  allow.  Treatment  should  be  directed  to 
the  relaxation  of  all  spinal,  intercostal,  and  cervical  tissues,  and  to  the  rais- 
ing of  the  ribs,  for  the  purpose  of  removing  obstruction  from  and  toning 
the  circulation  and  innervation  of  the  pleurae.  The  raising  of  the  ribs  and 
clavicle,  including  the  repair  of  the  particular  luxation  of  ribs  that  is  caus- 
ing the  trouble,  are  the  most  important  steps.  If  the  case  is  seen  before 
the  inflammation  and  exudation  has  progressed  far,  the  process  may  be 
more  eisily  stopped,  as  the  necessary  point  is  to  gain  control  of  circulation, 
which  may  be  readily  accomplished  through  nerves  and  x'essels  as  already 
explained.  In  the  stage  of  exudation,  where  quantities  of  the  exudate  occur 
in  the  pleural  cax'ities,  attention  must  be  given  to  releasing  the  tension  in 
parts  due  to  contractures  of  muscles,  etc.,  to  raising  the  ribs  to  allow  more 
free  play  of  the  lungs,  and  to  the  relief  of  the  pain  iu  the  side,  and  the  dis- 
tressing cough  by  carefully  raising  the  ribs  and  manipulating  the  tissues  at 
the  seat  of  the  pain.  But  the  main  point  at  this  stage  is,  by  the  treatment 
to  the  circulation,  to  hasten  the  resorption  of  inflammatory  products.    This 


72  PRACTICE  AND  APPLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

may  be  done  to  a  considerable  extent.  Great  care  must  be  taken  in  hand- 
ling the  patient  on  account  of  the  great  pain,  l^y  stimulating  the  process 
of  absorption,  and  by  keeping  the  parts  free  from  tension  in  the  tissues, 
also  by  keeping  up,  carefully,  free  motion  of  the  ribs  and  parts,  the  adhes- 
ions of  the  pleurae,  and  the  retraction  of  parts  likely  to  occur  as  a  result  of 
the  intlammation,  may  be  avoided.  This  is  during  the  con\alescence  of  the 
patient,  when  his  condition  must  be  carefully  watched.  The  point  ma)'  be 
reached  in  some  cases  where  tapping  might  be  necessary,  but  if  the  case  is 
seen  in  time  the  the  process  ma)-  be  so  controlled  as  to  obviate  this  diffi- 
cult)-. In  cases  of  adhesions  between  the  pleurae,  if  painful  they  should 
be  gradually  broken  up.  This  is  done  in  a  course  of  treatment,  carefully 
gi\ing  the  parts  concerned  the  extremes  of  motion  of  which  they  are  capa- 
ble. The  process  is  aided  by  developing  the  circulation  to  in  part  absorb  . 
the  adhesi\e  tissues.  This  must  frequently  be  done  in  the  chronic  case. 
The  treatment  of  such  cases  consists  mainly  in  restoration  of  lesion,  and  in 
maintaining  free  circulation  for  the  absorption  of  pus,  if  present. 

In  treatment  of  pleurisy,  stimulation  of  heart  and  lungs,  of  bowels, 
kidneys  and  superficial  fascia,  for  the  removal  of  poisonous  waste,  and 
attention  to  the  general  health  of  the  patient  are  necessary.  Acute  cases 
should  be  kept  upon  a  light,  easily  digested  diet.  Exposure  must  be  pre- 
vented. One  thorough  treatment  daily,  with  more  treatment  at  times  dur- 
ing the  day  for  the  relief  of  pain,  etc.,  will  usually  be  sufficient.  Chronic 
cases  should  be  treated  three  times  per  week. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV.  75 


PULMONARY  CONSUMPTION. 

Definition:  Pulmonary  Consumption,  or  Tuberculosis  of  the  Luno-s, 
is  a  destructive  disease  of  the  tissues  of  the  lungs,  characterized  by  the 
presence  of  the  ba/cillus  tuberculosis,  and  caused  by  specific  lesions  in  the 
upper  dorsal  and  thoracic  regions. 

Causes:  "'Ca^^^;  (i)  In  a  case  of  "quick  consumption,"  Acute  Pneu- 
monic Phthisis,  the  upper  dorsal  spine  was  swerved  to  the  right;  the  2nd 
dorsal  vertebra  was  lateral;  the  8th  and  gth  dorsal  vertebrae  lateral;  the  ribs 
down,  narrowing  the  thoracic  cavity.  Reported  cured  in  three  months' 
treatment.  (2)  Second  and  third  ribs  luxated;  marked  lesion  between  the 
corresponding  vertebrae  and  the  tissues  about  them  very  tender.  Three 
months'  treatment  so  benefited  the  patient  that  recovery  followed,  (3) 
First,  second  and  third  left  ribs  down  and  in.  Reported  cured.  (4)  Left 
clavicle  down;  1st  to  8th  dorsal  vertebrae  flat;  8th  dorsal  to  ist  lumbar  ver- 
tebrae posterior;  2nd  right  rib  tilted;  the  spine  and  thorax  flat.  (5)  The 
4th  dorsal  v^ertebra  sore;  3rd  to  5th  lumbar  vertebrae  tight  and  irregular; 
fifth  and  sixth  left  ribs  close  together;  first  rib  on  right  luxated;  all  ribs 
down  and  irregular.     Case  benefited. 

Lesions  are  often  found  of  the  2nd,  3rd,  and  4th  ribs;  of  the  5th,  6th,  7th 
and  8th  ribs  (A.  T.  Still);  2nd  and  3rd  cervical  vertebrae  usually  lateral,  and 
lesions  to  the  middle  and  inferior  cervical  sympathetic  ganglia  affecting  the 
iymphatics  of  the  lungs  (McConnell);  of  the  clavicle. 

Anatomical  ielations.  In  these  cases  the  neck  lesion  is  not  generally  of 
prime  importance,  the  dorsal  lesion  being  the  particular  one,  and  of  this 
variet}',  that  more  especially  affecting  the  upper  several  ribs.  Lesion  of 
the  spine,  muscles,  ligaments,  or  ribs,  as  low  as  the  loth  may  become  the 
cause  of  the  disease.  In  very  many  cases  the  lesion  will  be  found  to  in- 
volve the  second  dorsal  vertebra  or  the  second  rib. 

There  are  important  reasons  why  lesions  of  ribs  lead  to  pulmonary  tuber- 
culosis,and  why  the  flattened  thorax, characteristic  of  the  disease, is  so  closely 
related  to  the  condition,  either  as  primary  lesion  causing  it,  or  as  a  lesion 
secondary  to  it.  According  to  the  American  Text  Book  of  Physiology, 
stimulation  of  intercostal  nerves  causes  reflex  constriction  of  pulmonary 
vessels.  The  intercostal  nerves  are  all  connected  directly  with  the  S}'mpa- 
thetic  system  by  rami  communicantes,  and  the  sympathetic  vaso-dilator  and 
vaso-constrictor  fibres  of  the  system  are  situated  all  along  the  thoracic 
spinal  region.  Luxations  of  ribs  and  a  flattened  thorax  (dropped  ribs)  set 
up  irritation  in  the  intercostal  nerves,  leading  to  constriction  of  the  pul- 
monary vessels,  A  vast  area  may  be  affected  through  the  wide  distribution 
of  intercostal  nerves.  Very  general,  or  localized,  anemia  of  lung  tissues  fol- 
lows upon  pulmonary  vascular  constriction  caused  by  this  over  stimulation 
of  the  intercostal  nerves.     This  dexitalizes  the  tissues  of  the  lung,  and  gives 


76  PRACTICK  A.Vn  APPLIED  TMKRAPEUTICS  OF  Oi^TEOPATHV. 

a  foot-hold  to  the  pathogenic  bacteria, held  by  medical  authorities  to  be  the 
sole  cause  of  tuberculosis. 

With  regard  to  the  microbic  origin  of  this  disease,  the  Osteopath  does 
not  deny  the  presence  of  such  bacteria  in  the  lung,  nor  their  activit)-  in 
destruction  of  lung  tissue.  He  holds  that  there  is  necessary  a  lesion  to  the 
lung,  in  the  form  of  an  impediment  to  proper  nerve  and  blood  supply  to  the 
lung  tissues,  weakening  them  to  an  e.xtent  that  allows  the  bacteria,  which 
cannot  grow  in  healthy  tissues,  to  produce  their  kind  and  to  form  their 
toxins. 

It  has  already  been  pointed  out  that  the  vaso-motor  spinal  area  for  the 
lungs  (2nd  to  7th  dorsal),  and  particularl}'  the  region  of  the  2nd,  3rd,  and 
4th  thoracic  sympathetic  ganglia,  is  most  apt  to  suffer  from  lesion  in  dis- 
eases of  the  lungs.  Rib,  vertebral,  intercostal  or  spinal  muscular  lesion, 
etc.,  is  more  likely  to  cause  lung  disease  in  this  area  than  elsewhere.  It  is 
a  well  known  fact  that  the  apices  of  the  lungs  are  most  generally  the  seat  of 
the  disease.  This  fact  is  readily  explained  by  the  fact  that  upper  rib  and 
spinal  lesions,  most  frequent  in  consumption  of  the  lungs,  affect  this  region 
of  the  lung  generally,  centering  upon  this  important  vaso-motor  area.  The 
further  fact  that  the  apex  of  the  lung  is  not  usually  so  well  developed  on 
account  of  lazy  habits  of  breathing,  makes  lesion  in  this  region  more  im- 
portant. Anders  states  that  special  investigation  has  shown  that  the  dis- 
ease does  not  begin  at  the  tip  of  the  apex,  but  about  one  and  one-half 
inches  below,  near  the  postero-external  border.  Posteriorly  the  first  signs 
are  discovered  over  the  lower  part  of  the  supra  spinous  fossa;  anteriorly, 
immediately  below  the  middle  of  the  cla\icle,  along  a  line  about  ly^  inches 
from  the  inner  ends  of  the  second  and  third  intercostal  spaces.  The  start- 
ing point  may  also  be  located  at  the  first  and  second  intercostal  spaces  below 
the  outer  third  of  the  clavicle.  These  points  of  origin  of  this  disease  in  the 
lung  are  thus  in  close  relation  with  those  upper  ribs  apparently  most  often 
luxated  in  this  disease.  In  this  way  the  osteopathic  view  that  such  lesion 
causes  the  disease  is  supported  by  the  facts. 

Prognosis;  Except  in  late  and  serious  stages  of  the  disease,  the 
chances  of  limiting  its  progress  are  good.  Some  cases  may  be  cured. 
The  prognosis  as  to  recovery,  however,  must  be  guarded.  In  many  cases 
much  may  be  done  for  the  benefit  of  the  patient's  general  health. 

Treatment:  The  first  consideration  is  the  removal  of  the  specific  les- 
ion causing  the  trouble.  This  is  accomplished  by  methods  already  given. 
The  removal  of  lesion  has  frequently  been  followed  by  recovery.  On  the 
whole  a  considerable  number  of  cases  have  been  cured.  Thorough  spinal 
treatment  should  be  given  for  the  correction  and  upbuilding  of  the  vaso- 
motor activities.  The  spinal  muscles  and  deep  tissues  should  be  relaxed, 
and  the  ribs  should  be  raised  to  allow  the  greatest  area  of  expansion  possi- 
ble. The  vaso-motor  area  for  the  lungs  should  receive  especial  treatment. 
In  all  these  ways  the  blood-supply  to  the  lungs  is   upbuilt.     This,  next  to 


PRACTICK  AND  APPLIED  THERAPEUTICS  OE  OSTEOPATHY.  77 

the  removal  of  lesion,  is  the  main  consideration  in  the  treatment  of  the  case. 
Phagocjtic  activit}'  is  said  to  constitute  the  natural  power  of  resistance  of 
of  the  system  to  the  ba^cilli.  By  increasing  blood  supply  to  the  tissues 
phagoc)'tic  activity  is  increased,  the  tissues  are  strengthened,  and  the  en- 
croachments of  the  bacteria  are  limited.  As  they  cannot  live  and  pop4gate 
in  healthy  tissues,  and  as  pure  blood  is  a  germicide,  the  progress  of  the  dis- 
ease is  checked  as  soon  as  pure  blood  and  healthy  tissue  are  opposed  to 
to  them  in  equal  ratio.  Thorough  stimulation  of  the  functions  of  heart  and 
lungs  materially  aids  this  process.  The  very  important  nerve  connections  of 
the  lungs,  already  pointed  out  in  detail,  afford  the  Osteopath  the  surest 
means  of  reaching  this  result.  His  is  the  natural  method.  Strong  lungs 
remain  immure  to  this  disease  because  healthy  tissues  will  not  harbor  the 
microbe.  Consumptives  have  been  cured  by  judicious  exercise,  fresh  air, 
and  careful  regimen.  In  this  way  the  tissues  of  the  lung  have  been  built 
up,  the  circulation  to  it  has  been  increased,  and  the  bacteria  have  been 
crowded  out  by  the  gain  over  them  of  the  natural  healthy  processes  thus 
aroused.  Osteopathy  removes  the  impediment  to  normal  activities  of  the 
blood  and  ner\e  forces  that  make  strong  lung  tissue.  Its  method  does  that 
which  Nature  unaided  could  not  do, and  further  aids  Nature  to  recover  from 
the  weakness  caused  by  the  disease.  No  other  method  would  seem  more 
sure  of  chances  of  success  than   this. 

The  clavicles  should  be  raised,  and  the  pneumogastric,  phrenic,  and 
cer\ical  sympathetic  nerves, should  be  freed  and  toned  for  reasons  already 
explained.  Fresh  air,  judicious  exercise,  and  nutritious  diet  are  indispensa- 
ble factors  in  the  treatment.  Antiseptic  precautions  in  regard  to  the  pa- 
tient's sputum,  linen,  etc,  should  be  observed  as  directed  in  medical  texts. 
Bowels,  kidneys,  and  skin  should  be  stimulated  to  full  activity.  General 
circulation  must  be  increased. 

The  night  sweats  generally  soon  yield  to  the  spinal  treatment.  The 
coicgh  may  be  relieved  by  treatment  along  the  trachea  and  anterior  thorax, 
but  it,  as  well  as  'ihe  expectoratio)i,  fever,  and  hemorrhages^  are  relieved  and 
checked  by  the  favorable  progress  of  the  case.  The  greatest  care  must  be 
taken  for  the  patient's  general  condition  and  nutrition. 

Treatment  is  given  in  the  ordinary  chronic  case  three  times  per  week. 
In  the  acute  form  it  should  be  given  daily. 


CONGESTION  OF  THE  LUNGS. 

Defixition: — A  vaso-motor  disturbance  to  the  lungs,  resulting  in  en- 
gorgement  of  the  blood-vessels,  and  caused  by  lesions  in  the  upper  dorsal, 
thoracic,  and  cervical  regions. 

Causes: — The  lesions  producing  this  disease  may  be  any  of  the  lesions 
interfering  with  the  innervation,  especially  vaso-motor,  and  with  the   blood 


^8  PRACTICE  AND  APPLIED  THERAPEUTICS  OK  OSTEOPATHV. 

suppl)'  to  the  lungs.  These  have  been  described  in  the  discussion  of  the 
different  diseases  of  the  lungs  already  considered,  q.  v.  With  these  lesions 
present  and  weakening  the  circulatory  energy  in  the  lungs,  some  direct  ex- 
citing cause,  such  as  exposure,  over-exertion,  and  the  like,  may  bring  on  the 
attack.  In  the  passive  forms  of  congestion,  secondary  to  enfeebled  heart 
action  or  to  valvular  disease,  or  coming  on  through  stasis  of  blood  due  to  a 
long  continued  dorsal  position  of  the  patient,  also  in  the  active  form  of 
pulmonarj'  congestion,  when  the  trouble  ma)-  be  symptomatic  of  pneumonia, 
pleurisy,  etc.,  the  lesion  must  be  investigated  with  regard  to  the  actual  dis- 
ease, and  may  be  but  in  part  responsible  directly  for  this  condition. 

The  Prognosis  is  good. 

The  Treatment  must  be  directed  at  once  to  the  removal  of  the  speci- 
fic lesion  if  possible.  The  main  object  of  the  treatment  is  to  give  vaso- 
motor control.  As  soon  as  the  impeded  circulation  is  released,  and  activ- 
ity restored  to  the  innervation  of  the  vessels,  further  progress  of  the  dis- 
ease is  prevented.  As  in  the  first  stage  of  pneumonia  the  disease  wasaborted 
by  gaining  vaso-motor  control  of  the  parts,  so  here  the  whole  matter  rests 
upon  the  correction  of  the  circulation.  The  accelerators  of  the  heart,  2d  to 
cth  dorsal  on  the  left,  and  the  vaso-motors  of  the  lungs,  2d  to  the  7th  dor- 
sal, should  be  stimulated  at  once,  and  the  treatment  gives  immediate  relief 
from  the  dyspnea.  Often  ihe  patient  is  sitting  up  in  the  effort  to  get  air, 
and  the  practitioner  may  easil}-  stand  behind  and  thoroughl)-  treat  the  up- 
per dorsal  region,  releasing  contractured  muscles,  stimulating  the  centers 
mentioned,  and  raising  the  ribs.  Pressure  with  the  knee  upon  the  back, 
while  the  arms  are  both  raised  high  above  the  head,  expands  the  chest, 
draws  the  air  into  the  lungs,  and  aids  in  restoring  circulation.  This  work 
also  aids  the  process  b>'  increasing  activit)-  in  intercostal  vessels  and  ner\es. 
The  latter  should  be  thoroughly  treated  along  the  spine,  intercostal  spaces, 
and  over  the  chest  anteriorly,  as  stimulation  of  the  intercostal  nerves  has 
been  shown  to  cause  reflex  constriction  of  the  pulmonary  vessels.  Treat- 
ment should  be  given  the  pneumogastric  nerves,  and  any  cervical  lesion  to 
them  removed,  on  account  of  their  participation  in  the  pulmonar)-  plexus. 
Treatment  at  the  superior  cervical  region  for  general  vaso-motor  effect, 
and  in  the  abdominal  region  to  call  the  blood  away  from  the  lungs,  will  aid 
the  case.  In  cases  of  hypostatic  congestion  the  patient's  position  in  bed 
must  be  changed  so  as  to  drain  the  blood  from  the  parts  affected,  usually 
the  postero-inferior. 

Patients  are  usualh'  relieved  immediately  upon  treatment.  The  dys- 
pnea being  most  easily  relieved.  The  cough  and  blood)-  expectoration 
gradually  subside  with  the  betterment  of  the  case,  which  quickly  \ields  to 
treatment. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  79 


LARYNGITIS. 

Definition-. — An  acute  inflammation  of  the  mucous    membrane   lining 

.  the  larynx.     In  acute  and  chronic  catarrhal   forms    the    inflammation    is    a 

catarrhal  condition.      In  the  spasmodic  form   (laryngismus    stridulus),    the 

condition  is  a  nervous  one.       In  the   edematous    form    the  inflammation    is 

accompanied  hy  exudation  and  infiltration  ot  the  tissues. 

Causes:— Lesions  to  the  innervation  and  blood-supply  of  the  larynx 
are  present.  The  chief  ones  are  to  the  pneumogastrics  and  cervical  sympa- 
thetics,  and  occur  at  the  atlas,  axis  and  third  cervical  vertebra,  where  they 
affect  the  superior  cervical  ganglion,  and  through  it  the  nerves  in  question. 
Cervical  lesion  may  also  affect  the  other  cervical  sympathetics  concerned 
in  the  innervation  of  the  larynx-  These  lesions  affect  circulation  of  the 
larynx  through  the  innervation.  Direct  lesion  to  the  blood  vessels  may 
occur  at  the  clavicle  and  first  rib,  at  the  deep  anterior  cervical  tissues,  and 
in  the  muscles  along  the  neck  anteriorl\-  and  about  the  throat.  They  may 
obstruct  the  circulation  in  the  carotid  arteries  and  the  thyroid  axis,  or  ma\' 
impede  the  venous  return  through  the  small  veins  and  the  innominates  and 
internal  jugulars.  Local  weakness  of  the  glottis,  or  of  the  laryngeal  mus- 
cles, may  occur  primarily  or  secondary  to  other  lesion  The  edematous 
form  is  especiall)-  likel\-  to  be  caused  by  obstruction  to  the  internal  jugular 
veins.  Traumatism  ma)-  be  the  sole  cause,  or  cold,  exposure,  and  irritation, 
etc  ,  ma)'  act  secondarily  to  cervical  lesion  to  cause  the  disease. 

The  Prognosis  is  good.  Immediate  relief  is  obtained  from  the  treat- 
ment, and  reco\ery  soon  follows. 

In  dangerous  cases  of  edematous  laryngitis  great  care  must  be  taken. 
Tracheotomy  may  become  necessary  in  some  cases,  but  ordinarily  this  can 
be  avoided  by  the  treatment  if  the  case  be  seen   in  time. 

The  Treatment  must  be  directed  as  far  as  possible  to  the  immediate 
removal  of  the  specific  lesion.  This  releases  circulation  and  nerve  supplv 
as  shown  above.  The  tissues  of  the  neck,  particularly  of  the  throat,  must 
be  thoroughly  relaxed;  the  clavicle  is  raised,  and  the  deep  anterior  mujcles 
and  tissues  of  the  root  of  the  neck  are  treated.  These  treatments  free  the 
circulation  in  the  vessels  as  "^hovvn  abo\'e.  The  circulation  in  the  carotids 
is  further  aided  by  opening  the  mouth  against  resistance.  The  vagi  are 
treated  along  the  course  of  the  sterno-mastoid  muscle,  and  at  the  superior 
cervical  region.  Its  superior  laryngeal  branch  is  treated  behind  the  superior 
cornua  of  the  thyroid  cartilage.  Its  recurrent  laryngeal  branch  is  reachc  d 
at  the  inner  side  of  the  lower  portion  of  the  sterno-mastoid  muscle  at  about 
the  level  of  the  cricoid  cartilage. 

Deep  treatment  is  made  along  the  course  of  the  lar\nx  and  trachea, 
from  the  hyoid  bone  and  muscles  to  the  root  of  the  neck.  Care  must  be 
taken  to  apply  the  fingers  of  the  operating  hand  close    along    the    sides    of 


8o  PRACTICE  AM)  Al'I'LIKD    TIIEK APF.UTICS  OF  OSTEOPATHY. 

the  trachea.  This  is  excellent  treatment  for  the  huskiness  and  the  spasm. 
The  latter,  however,  is  apt  to  depend  upon  some  special  lesion.  In  spas- 
modic larynj^itis  the  epiglottis  is  sometimes  caught  in  the  rima,  and  must 
be  released  by  introducing  the  index  finger  into  the  throat.  Treatment  of 
the  phrenics  and  the  diaphragm  aid  in  lessening  the  spasm  by  quieting  the 
action  of  the  diaphragm.  A  warm  bath  is  recommended  to  break  up  the 
spasm. 

The  vagi  and  cervical  sympathetics  are  treated  at  the  superior  cervical 
region  and  along  the  posterior  region. 

Cases  of  aphonia,  due  to  the  changes  in  the  vocal  cords,  or  to  weakness 
of  the  epiglottis,  may  be  cured  by  this  treatment. 


TONSILLITIS. 

Definition: — Tonsillitis  is  an  inflammation  of  the  tonsils,  accompanied 
by  enlargement  of  the  gland,  fever  and  various  constitutional  symptoms. 
It  is  caused  by  lesions  in  the  cervical  region. 

Causes: — The  lesion  in  the  case  may  affect  the  general  cervical  region, 
but  usually  occurs  high  up.  affecting  the  atlas,  axis,  or  third  vertebra.  The 
lower  vertebrae  are  often  found  luxated,  and  contracture  of  the  posterior 
and  lateral  cervical  tissues  often  acts  as  the  primary  lesion.  Contracture  of 
the  upper  hyoid  muscles  is  always  present,  frequently  as  secondary  lesion. 
Luxation  of  the  clavicle  and  first  rib,  and  tension  in  the  deep  anterior  cerv- 
ical tissues  about  them  are  sometimes  found. 

Lesions  of  the  atlas,  axis,  and  third  vertebra  probabl)'  act  through  af- 
fecting the  fifth  nerve  through  its  connections  with  the  superior  cervical 
ganglion.  Lesions  of  the  lower  cervical  vertebrae,  and  or  the  posterior 
muscles  of  the  throat,  of  the  deep  anterior  cervical  tissues,  and  of  the  first 
rib  and  clavicle  have  an  important  effect  by  obstructing  the  circulation 
through  the  carotid  arteries  and  the  external  jugular  vein. 

In  persons  subject  to  tonsillitis  through  the  presence  of  these  specific 
lesions,  acute  attacks  are  frequently  aroused  by  exposure  to  cold  and  wet, 
by  bad  h)genic  surroundings,  and  by  various  nervous  disturbances. 

The  I'kognnsis  is  good  in  the  acute  follicular  and  acute  suppurative 
forms  and  in  ordinary  chronic  enlargement  of  the  glands.  One  or  a  few 
treatments  may  cure  the  case  in  the  acute  forms.  Great  relief  is  almost  in- 
\ariably  given  immediately  b)'  the  treatment.  The  chronic  enlargement 
requires  long  continued  treatment.  In  the  chronic  form,  described  also  as 
naso-pharyngeal  obstruction,  or  mouth  breathing,  the  prognosis  for  cure  is 
not  good.  Much  relief  can  be  given,  and  long  continued  treatment  aids  the 
retarded  mental  and  bodily  development. 

In  the  Treatment  of  acute  tonsillitis,  due  attention  must  be  gi\en  the 
general  constitutional  condition.      Liver,  bowels,  kidneys  and  skin   must  be 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  8l 

kept  active.  Thorough  spinal  treatment  should  be  given  for  tonic  effect. 
The  treatment  should  be  directed  at  once  to  the  reduction  of  the  spinal 
lesion.  Treatment  is  given  the  upper  three  cervical  vertebrae  to  affect  the 
superior  cergical  ganglion.  All  the  muscles  and  tissues  of  the  neck  are 
gently  but  thoroughly  relaxed.  Careful  treatment  is  made  over  the  supra- 
hyoid muscles  and  over  the  region  of  the  tonsils.  The  extreme  tenderness 
will  allow  of  but  gentle  treatment,  but  by  exercising  care  in  appUing  the 
treatment  at  first,  a  deep  and  thorough  treatment  may  be  given  after  pre- 
liminary relaxation  of  the  tissues.  All  the  cervical  vertebrae  and  posterior 
tissues  should  be  thoroughly  treated  for  the  sympathetic  connections  of 
the  fifth,  (XIII,  p.  21.)  The  treatment  over  the  throat  as  described  is  to 
relieve  the  inflammation  by  freeing  the  circulation  in  the  substance  of  the 
gland  and  in  the  carotid  and  external  jugular  veins.  As  the  large  arterial 
supply  is  from  branches  of  the  external  carotids,  particular  treatment  is 
made  along  them  by  relaxing  the  muscles  and  tissues  o\er  them  and  by  open- 
ing the  mouth  against  resistance  as  already  described.  This  work  over 
the  throat  is  carried  well  down  to  the  root  of  the  neck  over  the  carotid 
arteries  and  external  jugular  veins. 

Manipulation  over  the  tonsil  aids  the  flow  of  the  blood  through  the 
tonsillar  plexus  of  veins  into  the  external  jugular.  This  vein  is  freed  bv 
raising  the  clavicle  and  relaxing  the  anterior  cervical  tissues  about  it  and 
the  first  rib.  In  the  same  way  the  carotid  artery  is  stimulated  in  action. 
Circulation  in  the  substance  of  the  gland  is  aided  by  internal  treatment  in 
the  throat,  made  by  sweeping  and  pressing  the  index  finger  o\"er  the  gland, 
fauces  and  surrounding  tissues.  This  treatment  gives  much  relief.  All  the 
treatment  directed  to  the  throat  and  anterior  cervical  region  is  the  most 
important  part  of  the  treatment.  The  large  blood  suppl\'  of  the  gland,  and 
our  ability  to  reach  it  directly  more  than  through  the  innervation,  make 
this  part  of  the  treatment  important.  It  is  readily  efificient.  Ireatment  to 
the  first  rib  and  over  the  upper  anterior  chest  aids  circulation. 

The  tonsils  should  be  kept  free  from  accumulations  of  secretion'-,  which 
persist  in  chronic  cases.  The  fever  is  treated  in  the  usual  way,  being  af- 
fected by  the  superior  cervical  and  spinal  work.  The  spinal  and  general 
treatment  relieves  the  chilly  feelings,  aches,  etc.  The  neck  and  throat 
treatments  relieve  the  sore  throat.  Careful  treatment  will  prevent  suppura- 
tion in  the  suppurative  form.  The  general  tonic  treatment  must  be  persist- 
ent in  these  cases  because  of  the  severe  general  symptoms. 

Acute  cases  should  be  treated  daily  one  or  more  times  as  necessary.  A 
few  treatments  are  generall)'  sufTfi<:ient.  The  chronic  enlargements  (hyper- 
trophy) and  the  chronic  naso-phar)ngeal  obstruction  should  be  treated 
three  times  per  week.  In  the  latter  local  treatment  upon  the  gland  from 
within  the  throat  is  \er\'  helpful.  Long  continued  treatment  should  be 
urged  in  all  chronic  cases  to  prevent,  or  to  aitl,  retarded  mental  and 
physical  development. 


82  TKACTICE  AND  Ari'LIEO  TH  KKAF'EL'TICS  OF  OSTEOPATHY. 


PAROTITIS. 

Deitmtion:-  Parotitis  or,  mumps  is  an  acute  inflammation  of  the  par- 
otid glands. 

Causes: — The  lesions  in  such  cases  affect  the  upper  cervical  region, 
mainly  the  atlas,  axis  antl  third  vertebra.  Other  cervical  vertebrae  may  be 
luxated,  and  the  cervical  muscles  are  contractured.  The  deep  anterior 
cervical  tissues  may  be  tensed,  and  the  clavicle  luxated.  Secondary  con- 
tracture occurs  in  the  muscles  and  tissues  over  the  region  of  the  gland. 

Lesions  of  the  upper  three  cervical  vertebrae  and  to  the  tissues  affect 
the  superior  cervical  ganglion,  and  thus  the  carotid  plexus  through  its 
ascending  branch;  the  fifth  nerve  through  this  ganglion  and  through  its 
s>mpathetic  connections,  and  thus  its  auriculo-temporal  branch;  the  second 
cervical  nerve,  and  thus  its  auricular  branch;  while  lesions  to  the  muscles  in 
this  region  may  affect  the  facial  nerve  directly,  and  these  and  other  lesions 
affect  it  through  the  sympathetic  connections-  Contraction  of  the  tissues 
over  the  course  of  the  external  carotid  arteries  and  the  external  jugular 
veins  affect  the  flow  of  the  blood  to  and  from  the  gland.  Luxation  of  the 
clavicle  and  its  tissues  affects  the  external  jugular  vein. 

The  Prognosis  is  good.  Treatment  Is  rapidly  effective  and  the  course 
of  the  disease  is  shortened  from  the  usual  course,  seven  to  ten  days,  to 
three  or  four  days.  Some  cases  may  become  obstinate  and  require  longer 
treatment. 

The  Treatment  is  in  most  particulars  identical  with  that  given  for  ton- 
sillitis, q.  v.,  the  lesions  to  vertebrae,  tissues,  and  clavicle,  etc.,  being 
practically  the  same. 

The  tissues  over  and  about  the  gland  may  be  more  readily  relaxed  as 
the  condition  is  less  painful.  The  swelling  is  more  persistent,  and  requires 
more  treatment.  The  fever  is  treated  as  before,  and  a  thorough  spinal  and 
general  treatment  is  given  for  the  constitutional  symptoms.  This  should 
include  treatment  to  the  blood  and  nerve  supply  of  the  breasts,  ovaries,  and 
testacies  to  prevent  metastasis.  This  point  must  not  be  neglected,  as  the 
inflammation  may  be  driven  by  the  treatment  to  these  parts.  By  thor- 
ougii  treatment  of  them  the  danger  of  metastasis  is  much  lessened. 
Thorough  general  treatment  prevents  the  serious  sequelae  that  sometimes 
follow  parotitis.  Careful  nursing  and  care  of  the  patient  are  necessary  to 
prevent  relapse.     The  patient  should  remain  in  bed  during  the  acute  attack 


ACUTE  AND  CHRONIC  GASTRITIS. 

Definition: — The  acute  form  is  an  acute  catarrhal  inflammation  of  the 
mucosa  of  the  stomach;  acute  indigestion.  The  chronic  form,  chronic  dys- 
pepsia, is  associated  with  structural  changes  m  the  mucosa,  and  with  change 
in  the  secretions  and  muscular  activity  of  the  stomach. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  83 

Causes: — Lesions  have  been  noted  in  various  cases  as  follows:  (i)  2d 
to  6th  cervical  vertebrae  to  the  right;  2d  cervical  anterior;  8th  to  lOth  dor- 
sal vertebrae  separated;  break  at  the  fifth  lumbar.  (2)  Luxation  of  the  8th 
rib;  tenderness  at  the  Sth  dorsal  vertebrae.  (3)  cer\ical  and  dorsal  curva- 
tures of  spine,  and  luxation  of  the  ribs.  Lesions  at  the  atlas,  axis  and  third 
cervical  affect  the  vagus  nerve  through  its  connection  with  the  superior  cer- 
vical ganglion.  It  may  be  obstructed  along  its  course  in  the  neck.  Lesions 
to  the  cervical  region  and  to  the  pneuniogastric  nerves  in  the  neck  are  of 
secondary  importance  in  causing  stomach  disease.  The  main  lesions  occur 
in  the  spine,  affecting  the  splanchnic  area,  and  may  be  of  the  ribs  and 
their  cartilages,  of  the  vertebrae,  or  of  the  spinal  and  intercostal  muscles 
and  other  tissues  mentioned.  Lesions  to  these  structures  occur  mainly  be- 
tween the  fourth  and  tenth  dorsal  region,  but  may  occur  either  a  little  above 
or  below  these  limits  The  pneumogastrics  and  the  splanchnics  both  con- 
tribute to  the  solar  plexus,  which  has  charge  of  the  functional  activities  of 
the  organ.  The  wide  area  of  origin  of  the  splanchnics  along  the  spine,  and 
their  importance  in  the  innervation  of  the  stomach,  accounts  for  the  fact 
lesions  to  this  area  are  most  potent  in  producing  derangement.  At  the 
same  time  this  region  is  so  readilx'  accessible  to  the  Osteopath's  work  that 
results  are  general!)'  easily  attained  in  the  treatment  of  such  troubles. 

Lesions  to  ribs  and  cartilages  act  in  part  through  interference  iwth  the 
intercostal  nerves,  which  are  in  direct  s\  mpathetic  connection  with  the 
solar  plexus  through  the  splanchnics.  Luxation  of  the  ribs  may  also  inter- 
fere with  spinal  nerves  by  derangement  of  the  tissues  about  the  head  of  the 
rib.  Lesions  of  spinal  muscles,  ligaments,  and  vertebrae  act  mainly  through 
interference  with  the  spinal  nerves  and  thus  upon  the  connected  splanch- 
nics. Muscular  lesion  may  often  be  secondary  to  stomach  disease,  but  in 
such  case  indicates  the  point  of  treatment,  and  may  point  to  other  spinal 
lesion  at  that  place.  The  vagi  nerves  carry  sensory,  motor  and  secretory 
fibers  to  the  stomach.  The  splanchnics  contain  vaso-motor  and  vaso-inhib- 
ititory  fibers  for  the  stomach.  But  as  the  influence  of  the  abdominal  brain 
is,  according  to  Robinson,  supreme  over  visceral  circulation,  and  controls 
as  well  visceral  secretion  and  nutrition,  the  results  of  our  treatment  upon 
the  pneumogastrics  and  the  splanchnics  must  affect  the  stomach  mainl}' 
through  the  solar  plexus.  As  the  splanchnics  contain  these  vaso-motors 
for  the  stomach,  the  main  treatment  for  gastritis,  a  vasomotor  disturb- 
turbance,  must  be  through  them.  Lesions  to  the  splanchnic  area  are  likely 
to  cause  gastritis  upon  account  of  their  being  the  vaso-motors. 

McConnell  states  that  lesion  of  the  eighth  and  ninth  costal  cartilages 
may  cause  gastritis. 

The  mechanical  irritation  of  coarse,  poorl}-  masticated  food,  the  fermen- 
tation of  over-ripe  fruit  in  the  stomach,  and  the  effects  of  constant  over- 
loading of  the  stomach  and  of  indiscretion  in  diet,  may  irritate  the  mucosa 
and  cause  gastritis  in  the  absence  of  specific  lesion.     But  in  such  cases  sec- 


84  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

otidary  lesions  are  generally  produced  by  the  trouble.  In  the  ordinary 
case  of  gastritis  some  causes  beyond  these  must  be  sought,  as  the  disease  so 
frequently  occurs  without  such  indiscretions. 

The  Prognosis  for  recovery  is  good  in  both  acute  and  chronic  cases. 
The  ordinary  acute  case  is  relieved  immediately  by  a  treatment.  More  than 
one  treatment  may  not  be  necessary.  In  chronic  cases,  even  when  severe 
and  of  very  long  standing,  relief  is  soon  given,  and  a    cure    can    usually    be 

made. 

The  Treatment  must  be  directed  to  the  specific  lesion,  generally  of 
the  splanchnic  area,  that  is  causing  the  trouble.  Its  main  object  must  be  to 
correct  the  circulation,  and  thus  ts  take  down  the  inflamed  condition  of  the 
mucosa  and  restore  normal  secretion.  The  ?planchnics  and  solar  plexus, 
having  charge  of  the  circulation  and  secretion,  afford  a  m.ost  convenient 
means  of  doing  this.  The  correction  of  lesion  here,  and  the  treatment 
given  the  splanchnics  and  solar  plexus  in  conjunction  with  the  removal  of 
lesion  constitute  the  main  treatment  in  such  cases. 

With  the  patient  lying  upon  his  side  or  upon  his  face,  the  muscles  and 
deep  tissues  of  the  splanchnic  area  are  thoroughly  treated  and  relaxed.  The 
patient  now  lies  upon  his  side,  or  sits  up,  and  treatment  is  given  the  spinal 
vertebrae  and  ribs  of  this  region.  The  former  are  thoroughly  treated  and 
sprung,  to  relax  all  their  related  tissues  and  remove  obstructions  to  the 
nerves.  The  latter  are  raised,  and  adjusted  in  case  of  lesion,  to  aid  in  this 
process.  Vaso-motor  activity  is  thus  aroused  and  corrected.  This  import- 
ant process  is  aided  by  by  deep  treatment  of  the  solar  plexus  from  the 
abdominal  aspect.  (VI.  p  36)  As  this  plexus  has  the  main  control  of  visceral 
circulation  and  secretion,  treatment  of  it  rouses  and  normalizes  its  functions. 
Mechanical  pressure  of  displaced  ribs  upon  the  stomach  may  be  found. 
The  upper  abdominal  treatment  aids  circulation  in  the  stomach.  (V,  p  36). 
Attention  is  given  the  upper  cervical  region  for  lesions  affecting  the  vagus. 
It  may  be  treated  in  the  neck  as  a  means  of  aiding  the  general  treatment. 
Inhibition  by  pressure  upon  the  left  vagus  relaxes  the  pylorus.  This  press- 
ure may  be  made  in  the  neck  directly  upon  the  nerve,  or  may  be  made  at 
the  third  or  fourth  intercostal  space  near  the  spine.  This  latter  treatment 
is  much  used  to  relieve  nausea  and  vomiting.  Its  effect  is  probabl\- through 
the  sympathetic  connections  with  the  vagus.  In  some  cases  pressure  at 
this  intercostal  space  has  caused  vomiting.  In  some  cases  abdominal 
manipulation  induces  vomiting.  This  should  be  encouraged  to  relieve  the 
stomach  of  its  irritating  contents.  Excessive  vomiting  should  be  checked 
A  thorough  treatment  along  the  spine  (splanchnic  area)  will  aid  in  this. 
After  inhibition  qf  the  left  vagus  to  relax  the  pjlorus,  the  patient  may  be 
placed  upon  his  right  side  and  deep  pressure  Le  made  over  or  beneath  the 
left  hypochondrium,  from  the  cardiac  toward  the  pyloric  end,  to  aid  in  the 
passage  of  the  stomach  contents  into  the  intestine. 

McConnell  states  that  inhibition  at  the  8th  and  9th  dorsal  relaxes  the 
pylorus;  inhibition  at  the 6th  and  7th  dorsal  relaxes  the  cardiac  orifice.  He 
has  found  that  correction  of  lesion  in  the  lower  left  ribs  aids  in  the  absorp- 
tion of  gas.     Deep  pressure  over  the  solar  plexus  also  aids  this  process. 

Liver,  bowels,  and  kidneys  must  be  kept  in  active  condition  b\'  treat- 
ment. The  patient  should  be  absteminous  in  diet.  It  should  be  light  and 
easily  digested,  and  ma}-  be  according  to  prescribed  dietaries. 

Acute  cases  should  be  treated  frequently,  chronic  cases  three  times  per 
week. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  85 


DISEASES  OF  THE  STOMACH  (Continued.) 

Cases. —  (i)  Strain  from  heav)-  lifting,  followed  by  se\-ere  lameness 
at  the  time,  which  gradually  disappeared.  In  a  few  months  severe  stom- 
ach disease  followed;  no  food  could  be  retained,  and  rectal  feeding  was  re- 
sorted to.  He  came  under  treatment  too  weak  to  walk  or  talk.  Muscular 
contractures  under  the  right  shoulder  and  a  slightly  displaced  rib  were  the 
lesions  found.     They  were  corrected  and  the  case  was  cured. 

(2)  Ulceration  of  the  stomach  and  a  complication  of  troubles,  due  to 
spinal  curvature.     Correction  of  curxature  gave  great  relief. 

(3)  Ascidity  of  the  stomach  and  diarrhoea,  caused  by  abnormal  ten- 
sion in  the  spinal  tissues.       Cured. 

(4)  Gastralgia;  attacks  so  severe  that  they  induced  spasm  in  abdominal 
and  neck  muscles  at  the  same  time.  The  spasm  was  always  stopped  at 
once  by  inhibition  of  the  solar  plexus  and  of  the  posterior  cervical  nerves. 
Attacks  grew  less  frequent  under  treatment. 

(5)  Gastralgia;  agonizing  pain  followed  taking  even  small  quantities 
of  food  as  long  as  it  remained  in  the  stomach.  6th,  7th,  and  8th  right  ribs 
were  down.  These  being  replaced  at  the  second  treatment  the  trouble 
disappeared. 

(6)  Gastralgia  of  several  years'  duration.  Lesions  at  5th  and  6th  dor- 
sal and  2d  lumbar  \'ertebrae.  Luxation  of  the  8th  right  rib.  Case  cured  by 
four  months'  treatment. 

(7)  Tenderness  over  the  stomach  (hyperaesthesia) ;  8th  dorsal  verte- 
bra very  tender  and  8th  rib  luxated;  cured  by  two  weeks'  treatment. 

(8)  Gastralgia;  three  years'  standing;  attacks  after  nearly  every  meal. 
Lesion,  a  lateral  twist  of  the  6th  dorsal  vertebra.  Cured  in  one  \-ears'  treat- 
ment. 

(9)  Gastralgia;  incessant  pain  in  left  side,  stomach,  and  bowels;  4th 
and  5th  right  and  left  ribs  drawn  together;  8th  left  rib  under  7th;  spinal 
muscles  tense.     Great  relief  was  given  b)'  one  months'  treatment. 

(10)  Dilatation  of  the  stomach  and  a  complication  of  diseases.  The 
spine  was  straight  and  flat;  thorax  flat;  2d  and  3d  cervical  vertebrae  lateral; 
left  cervical  muscles  tense;  siiyht  lateral  curvature  to  left  between  the  5th 
dorsal  and  3d  lumbar;  spinal  muscles  tense. 

(11)  Gastralgia.  Seventh  dorsal  vertebra  right;  great  tension  at  the 
I2th  dorsal. 

(12)  Gastralgia.     Lesions  at  atlas  and  4th  dorsal. 

(13)  Gastralgia.      Luxation  of  the  nth   rib. 

Lesions:  In  all  the  above  cases  the  splanchnic  area  was  affected;  neck 
lesion  was  rare,  and  apparently  of  secondar)-  importance;  lesions  to  the  spine, 
including  vertebrae  and  muscles  were  important,  occurring  in  ten  of  the 
cases;  rib  lesions  were  the  most  important  and  specific,  occurring    in   seven 


86  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

of  the  cases.     Lesions  of  the  5th  to  8th  ribs  (area  of  greater  splanchnic)  oc- 
cur most  frequently. 

Lesions  to  the  splanchnic  area,  through  rib  or  spinal  lesion,  apparently 
occur  in  all  cases  of  stomach  disease.  We  are  not  yet  able  to  specialize  as 
to  lesion,  and  saj-  that  one  particular  style  of  lesion,  or  lesion  of  some  ind- 
ixidual  rib  or  vertebra  causes  a  certain  kind  of  stomach  disease. 

It  is  probable  that  in  the  future  compilation  of  lesions  niay  show  con- 
siderable specilization  of  them  in  the  etiology  of  stomach  disease.  But  it 
is  also  likely  that  such  tabulation  will  indicate  the  probabilities  onl\-,.for  it 
is  a  matter  of  experience  that  a  given  lesion  will  produce  in  one  patient  one 
form  of  stomach  disease,  and  in  another  a  different  form,  depending  upon 
individual  peculiarities,  and  upon  various  attendant  conditions.  Hence  one 
must  be  upon  the  lookout  for  an)-  various  lesion  in  the  splanchnic  area  in  all 
stomach  diseases.  The\-  ma\'  cause  a  predominance  of  sensory,  motor,  se- 
cretory, or  motor  derangements,  and  complications  thereof,  and  according 
to  the  pre  Jominating  difficulty  it  may  be  that  special  lesion  will  be  sus- 
pecteti,  or  that  special  areas  will  be  treated  in  conjunction  with  the  removal 
of  specific  lesion  in  the  case. 

The  practitioner's  simple  duty  in  stomach  disease  is  mostly  thorough 
examination  of  the  splanchnic  region  of  the  spine,  justabo\e  and  just  be- 
low, and  of  the  thoracic  parts  in  relation  thereto.  When  he  has  done  this 
he  has  located  the  trouljle,  almost  invariabl)-,  and  his  treatment  of  this, 
region,  removing  the  lesion,  ahnost  as  generall)'  cures  or  benefits  the  case. 
Lesion  outside  of  this  area  is  of  minor  importance,  and  treatment  directed 
elsewhere  (abdomen  and  neck)  is  either  secondary  or  for  alleviation  merel}'. 

Special  lesions  ha\e  been  noted  as  fallows:  in  ascidit)-.  the  lesser 
splanchnics  and  the  4th  and  5th  dorsal  (A.  T  Still);  in  gastralgia,  frequent 
luxation  of  the  8th  and  9th  ribs  anteriorl\-  ( McConnell),  also  of  the  5th,  6th 
and  7th  dorsal;  for  gas  on  the  stomach,  the  lesser  splanchnics  and  the  i  ith 
and  12th  dorsal;  for  gastric  ulcer,  frequent  lesion  of  the  8th  and  9th  ribs  an- 
teriorly, and  of  the  5th  to  Sih  ribs  posteriorly  (McConnell.) 

Secondary  lesion  in  the  form  of  contracturing  of  spinal  muscles,  par- 
ticularly along  ths  splanchnic  area,  is  of  very  frequent  occurrence  in  stom- 
ach disease.  Although  in  this  case  the  result,  and  not  the  cause,  of  stomach 
disease,  it  is  of  much  importance  osteopathically.  (i)  It  indicates  the 
point  of  treatment,  for  it  is  an  indication  upon  the  surface  of  the  body  of 
what  special  nerve  fibers  or  areas  are  suffering  derangement  by  the  particu- 
lar form  of  disease  present.  There  is  a  direct  path  between  the  diseased 
stomach  and  the  contractured  muscle,  over  which  the  abnormal  impulses, 
generated  in  the  stomach,  pass  out.  It  is  Nature's  landmark  of  a  special 
diseased  condition,  or  of  a  phase  thereof.  Experience  shows  that  in  the 
absence  of  an}-  other  lesion  whatsoever,  treatment  at  the  point  of  contract- 
ure may  cure  the  condition.  It  is  evident  that  the  nerve  era  thus  indicated 
was  the  one  needing  treatment. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  87 

(2)  These  contractures  do  not  always  occur  at  the  same  location,  nor 
always  affect  the  spinal  muscles  over  the  splanchnic  area  generally.  They 
may  occur  upon  the  one  side  of  the  spine  only,  high  up  in  the  splanchnic 
area  or  above  it.  They  must  therefore  indicate  lesion  in  different  nerve 
areas  or  fibers,  according  to  some  condition  present  and  determining  which 
fibres  shall  thus  suffer  and  produce  contracture.  It  is  possible  that  they  in- 
dicate seat  of  lesion  in  the  spine  not  otherwise  discoverable.  In  such  case 
this  weak  point  would  be  the  determining  condition  in  the  location  of  the 
situation  of  the  contracture.  Thorough  treatment  at  this  point  may  restore 
conditions  and  thus  correct  lesion  which  is  important  in  the  causation  of 
the  stomach  disease.  Contracture  and  soreness  in  the  cervical  or  lumbar 
regions  may  follow  stomach  disease,  and  possibly  indicate  important  rela- 
tions, by  lesion  or  otherwise,  between  these  parts. 

Anatoviical  Relations:  Robinson  states  that  the  solar  plexus  is  supreme 
over  visceral  circulation,  that  it  controls  also  secretion  and  nutrition.  The 
important  lesions  noted  in  stomach  trouble  affect  its  spinal  connections, 
the  splanchnics,  and  may  therefore  cause  circulator)-,  secretory,  or  nutri- 
tional disturbances  in  its  connected  organs.  Likewise  they  may  cause 
sensor)'  and  motor  troubles,  as  the  same  authority  states  that  this  plexus 
recei\'es  sensation  and  sends  out  motion.  According  to  Ouain,  the  terminal 
branches  of  the  pneumogastric  unite  with  the  gastric  plexus  of  the  sympa- 
thetic, and  carry  motor  and  sensor)^  fibers  to  the  stomach.  Flint  shows, 
that  the  pneumogastrics  have  much  to  do  with  gastric  secretions,  as  -^k^f^^ 
dioa-of  them  leads  to  almost  complete  cessation  of  stomach  secretions.  It 
is  considered  probable  by  investigatosr  that  its  motor  function  in  the 
stomach  is  deri\-ed  from  its  sympathetic  connections.  Osteopathic  work 
seems  to  influence  it  more  largely  through  its  sympathetic  connections.  It 
is  treated  also  in  the  neck  directl)'.  It  is  important  in  sensory  and  motor 
diseases.  The  splanchnics  contain  vaso  and  viscero-ih^orof'TtbTe's.  '^  Stimu- 
latiotL-oi  the  splanchnics  lessens  peristalsis;  of  the  pneunioorastricsj^ncreases 
it.  Thus  important  control  is  gained  in  various  conditions.  Quain 
states  that  sensory  nerves  for  the  stomach  pass  from  the  dorsal  nerves  from 
the  6th  to  the  9th;  the  6th  and  7th  supplying  the  cardia,  the  8tb  and  9th  to 
the  pyloric  end. 

The  Prognosis  in  stomach  diseases  as  a  class  is  extremely  good.  Many 
severe  cases  of  long  standing  have  been  cured.  As  a  rule  relief  is  immedi- 
ately given,  and  cure  follows. 

The  Treatment  of  stomach  diseases  as  a  class  is  very  simple.  It  con- 
sists mainl)'  in  corrective  treatment  in  the  splanchnic  area,  together  with  a 
certain  amount  of  neck  and  abdominal  work.  This  is  supplemented  b)- 
certain  special  treatments  for  various  purposes  in  the  treatment  of  special 
diseases.  Through  the  pneumogastrics  and  the  s)-mpathetic  connections, 
the  solar  plexus  and  the  splanchnics,  control  is  had,  to  a  marked  degree, 
over  the  processes  regulated  by  them;  sensation,    motion,    nutrition,   secre- 


88  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY, 

tion,  circulation.  Few  diseases  can  remain  after  correction  of  these  func- 
tions by  removal  of  the  lesion  disarranging  them. 

The  treatment  of  the  solar  plexus,  the  spine  (splanchnics),  the  pneu- 
mogastrics,  and  the  removal  of  the  various  lesions  likely  to  occur  in  these 
regions  have  already  been  discussed. 

The  various  motor,  secretory,  and  sensory    neuroses,- described   under 

the  general  name  of  nervous  dvspcpsia,  are  treated  by  the  removal  or  special 

lesion  and  by  the  work  for  the  control  of  various  functions  as  discussed,   Iji 

/  cases  of  supermotjlity,  peristaltic  unrest,    and    nexvous    eructation^   special 

\    treatment  may  be  given  to  stimulate  j^he  splanchnics   and    solar  plexus    to 

I   lessen  peristalsis.     In  nervous  vomiting,  the  work  should  be  directed  to  the 

Icerebral  centers,  by  treatment  in  the  superior  cervical    region,  and    to   the 

solar  plexus. 

In  spasm  of  the  cardia,  inhibition  should  be  made  at  the  end  of  the  6th 
and  /th  dorsal  for  fibers  controlling  it,  while  in  spasm  of  the  pylorus  the  in- 
hibition should  be  upon  the  8th  and  gth  dorsal  and  upon  the  left  vagus 
(p.  84).  Inaton)'  of  the  stomach,  thorough  stimulation  should  be  given  the 
vagi,  splanchnics  and  solar  plexus,  to  increase  muscular  tone  and  to  devel- 
op circulation.  Local  manipulation  over  the  region  of  the  stomach  would 
aid  in  toning  the  muscular  walls  (p.  84).  In  insufficienc)'  of  the  cardia 
stimulation  should  be  gi\'en  the  6th  and  7th  dorsal,  while  in  p}'loric  insuf- 
ficiency the  8th  and  gth  dorsal  and  the  left  vagus  must  be  looked  to.  Local 
stimulation,  by  brisk  work  over  the  abdomen,  aids  the  operation. 

In  secretor)'  disturbances,  hyper-ascidit)-,  super-secretion,  and  sub- 
ascidit)-,  work  upon  the  vagus  and  solar  plexus,  through  the  splanchnics, 
corrects  circulation  and  rights  secretion.  Stimulation  of  the  lesser  splanch- 
nics and  of  the  4th  and  5th  dorsal  is  important. 

In  sensory  disorder  attention  must  be  given  the  sensory  innervation. 
Hvperaesthesia  needs  a  general  stimulation.  Gastralgia  needs  deep  inhi- 
bition at  the  solar  plexus,  splanchrics,  and  vagi.  Special  inhibition  should 
be  made  from  the  6th  to  gth  dorsal,  8th  and  gth  ribs  anteriorly,  and  the  5th, 
6th,  and  7th  dorsal  vertebrae.  All  of  which  points  seem  concerned  in  the 
sensory  innervation  of  the  stomach.  For  the  abnormal  sensations  of 
hunger,  lack  of  appetite,  etc.,  general  correction  of  secretions  and  sensation 
will  be  efficient. 

For  dilatatio7i  of  the  stomach,  rapid  cutaneous  stimulation  over  the 
region  of  the  stomach  aids  in  contracting  its  muscular  fibers.  Treatment 
should  be  given  for  the  stimulation  of  the  vagi,  and  accumulated  food  must 
be  kept  worked  out  of  the  stomach,     (p,  84.) 

\\\  peptic  tdce>  attention  should  be  given  to  perfect  freedom  of  circula- 
tion. The  condition  of  the  8th  and  gth  ribs  anteriorly,  and  of  the  5th  to  8th 
ribs  posteriorly  must  be  looked  to. 

In  hemorrhage  from  the  stomach,  inhibit  the  splanchnics,  and  the  solar 
plexus  carefully,  to  lessen  the  blood  pressure  by  vaso-dilatation.     Also  in- 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  89 

hibit  the  superior  cervical  region  for  the  general  vaso-motor  center,  and 
make  deep  inhibitive  treatment  of  the  abdomen  to  dilate  the  great  abdom- 
inal veins  and  call  the  blood  away  from  the  stomach. 

In  ca7icei' oi  the  stomach  general  corrective  work  and  particular  atten- 
tion to  freedom  of  circulation   must  be  relied  upon. 

Look  for  lesion  to  an)'  of  the  special  points  mentioned  in  relation  to 
the  various  diseases.  The  bowels,  kidne}s  and  liver  must  be  kept  in  free 
action.     The  diet  should  in  all  cases  be  limited  and  easil)-  digested. 


CONSTIPATION. 

Definition:  "Infrequent  or  incomplete  alvine  evacuation,  leading  to 
retention  of  feces"  (Quain).  "A  neurosisof  the  fecal  reservoir"  (Byron 
Robinson).  Osteopathicall)-  it  is  regarded  as  a  neurosis  due  to  obstructed 
action  of  the  nerves  supplying  the  bowel  with  secretion,  motion,  and  circu- 
lation. It  may  be  symptomatic  of  other  disease,  or  a  complication.  It  is 
very  frequently  idiopathic,  due  to  specific  lesion  to  bowel  innervation. 

Cases  have  presented  vd^rxous  lesions;  {\)  Contraction  of  the  sigmoid 
flexure.  (2)  Spinal  lesions,  mostly  in  the  lumbar,  causing  spinal  cord  dis- 
ease and  partial  paral}'sis  of  limbs  and  bowel  (3)  A  posterior  prominence 
of  the  whole  lumbar  region.  (3)  Lesion  at  5th  and  6th  dorsal,  2nd  lumbar, 
and  8th  right  rib.  (5)  At  3rd  and  4th  dorsal,  9th  dorsal,  5th  lumbar.  (6) 
Intense  contraction  of  the  external  sphincter  ani.  (7)  Slight  parting  of  1st 
and  2nd  lumbar.  (8)  Prolopsus  of  the  sigmoid.  (9)  Retroversion  of  the 
uterus  against  the  rectum.  (10)  Right  curve  of  spinal  column ;  3rd  to  6th 
dorsal  vertebrae  posterior;  7th  to  loth  dorsal  vertebrae  anterior  and  flat; 
nth  and  12th  dorsal  and  ist  lumbar  posterior;  12th  dorsal  and  1st  lumbar 
the  seat  of  pain;  12th  rib  down;  2nd  and  3rd  lumbar  close;  5th  lumbar  sore 
and  anterior,  (ii)  2nd  and  3rd  dorsal  separated,  3rd  and  4th  together, 
3rd  to  5th  flat,  6th  to  the  left,  nth  dorsal  to  2nd  lumbar  posterior.  (12)  6th 
and  7th  dorsal  posterior,  9th  to  12th  flat,  ribs  irregular  and  prominent  on 
the  left.  (13)  Cocc)-x  badly  bent,  lesion  of  5th  lumbar.  (14)  Separation 
between  \-ertebrae  from  8th  to  lOlh  dorsal,  and  between  5th  lumbar  and 
sacrum.  (15)  2nd  to  5th  dorsal  approximated  and  to  the  right,  separations 
between  \ertebrae  from  8th  dorsal  to  3rd  lumbar,  the  right  innominate  up 
and  back. 

An  examination  of  cases  shows  a  wide  distribution  of  lesion,  ranging 
from  the  upper  dorsal  to  the  coccyx,  and  affecting  ribs,  vertebrae,  spinal 
muscles  and  other  tissues,  innominates,  coccyx,  etc.  The  most  important 
lesions  in  these  cases  appear  in  the  region  of  the  lower  two  or  thfee  dorsal, 
and  in  the  lumbar  region.  It  is  in  this  portion  of  the  spine  that  origin  is 
given  to  the  sympathetic  nerves  supplying  the  bowel.  Particular  attention 
should  be  given  the  nth  and  12th  dorsal  and  the  1st  and  2nd  lumbar,  as  the 


QO  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

sympathetic  branches  from  these  points  supply  the  inferior  mesenteric 
ganglion  and  the  rectum  with  motor  fibres,  and  the  abdominal  vessels  with 
constrictor  fibres.  Sympathetic  distribution  for  the  small  intestine  is  from 
just  above  the  first  lumbar;  for  the  large  intestine  from  the  ist  to  4th  lum- 
bar. Hence  the  importance  of  the  lower  dorsal  and  lumbar  lesion  in  con- 
stipation, as  it  may  interfere  with  the  functions  of  motion,  secretion,  and 
circulation  by  obstructing  the  spinal  connections  of  these  importani  sym- 
pathetics. 

Lesions  of  the  lower  two  ribs  are  important  causes  of  constipation,  not 
only  by  spinal  interference  with  the  sympathetics  mentioned,  but  by  direct 
mechanical  pressure  upon  the  bowel,  sometimes.  In  )'ct  another  important 
manner  they  ma)-  cause  bowel  trouble  b)-  lesion  to  the  diaphragm  as  already 
mentioned.  The  whole  subject  of  change  in  the  diaphragm  is  an  important 
one  in  relation  tu  bowel  disease.  It  is  reasonable  to  consider  that  certain 
spinal  and  rib  lesions  affect  the  diaphragm.  They  may  cause  it  as  a  whole 
to  weaken  and  sag,  may  cause  contracture  of  the  whole  muscular  structure, 
or  may  contracture  or  strain  certain  portions  of  it.  Thus. impingement  is 
brought  upon  the  important  structure  passing  through  the  diaphragm,  and 
having  much  to  do  with  abdominal  activities.  The  aorta,  ascending  cava, 
thoracic  duct,  pneumogastrics,  phrenics,  and  splanchnics — may  be  inter- 
fered with.  Or  the  sagging  of  the  diaphragm  may  set  up  ptosis  of  the 
abdominal  organs,  thus  causing  constipation  mechanically  or  otherwise. 
This  subject  has  been  discussed  at  length  elsewhere. 

Lesion  to  the  fourth  sacral  nerve  may  cause  contracture  of  the  external 
sphincter,  which  it  innervates.  Lesion  to  the  lower  dorsal  and  the  lumbar 
nerves  may  lead  to  loss  of  energy  of  the  muscles  of  the  abdominal 
walls,  as  ma)'  other  causes,  and  lead  to  constipation.  Robinson  states  that 
such  a  condition  favors  constipation  by  allowing  congestion  of  blood  and 
secretions.  Lesions  to  the  liver  and  pancreas,  usually  from  the  8th  to  i2th 
dorsal,  or  through  the  splanchnics  or  solar  plexus,  aid  constipation  by  less- 
ening the  secretions  of  these  organs,  necessary  to  stimulation'bf  peristalsis. 
McConnell  states  that  contractured  muscles  are  generall)'  found  in  consti- 
pation on  the  right  side  of  the  spine  over  the  region  of  the  liver.  Dr.  Still 
makes  lesion  of  the  5th  dorsal  important  in  these  cases. 

The  cocc)'x  may  be  so  misplaced  as  to  act  as  a  mechanical  obstruction 
to  the  passage  of  the  stool.  Lesion  at  this  point  may  cause  contracture  of 
the  sacral  tissues  and  interfere  with  the  fourth  sacral,  or  it  may  interfere  in 
a  similar  manner  with  the  sympathetic  distribution  to  the  rectum  and  cause 
atony  or  contracture  of  its  walls.  A  prolapsed  uterus,  hernia,  adhesions,  or 
the  presence  of  foreign  bodies,  fruit  stones,  etc.,  may  mechanically  obstruct 
the  bowel. 

\'arious  lesions,  as  of  the  diaphragm,  the  weight  of  a  loaded  colon,  of 
the  spinal  regions,  etc.,  producing  ptosis  of  the  abdominal  organs,  or  of  the 
colon  itself,   cause  a   kinking  of  the   flexures  by  their  dragging  upon  their 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  91 

ligaments  at  those  points.  The  same  causes  allow  of  a  sinking  of  the 
caecum  and  sigmoid  into  their  respective  iliac  fossae,  allowing  also  the  sig- 
moid to  fold  upon  itself.  In  these  ways  obstruction  to  the  passage  of  fecal 
matter  along  the  bowel  is  caused.  In  enteroptosis  the  pressure  of  organs  upon 
each  other  limits  motion,  peristalsis,  and  circulation.  The  elongated  omenta 
and  ligaments,  in  which  the  blood  vessels  and  nerves  run  to  the  bowels, 
stretch  these  structures  and  abridge  their  function.  These  become  import- 
ant causes  of  constipation. 

The  anatomical  relations  have  been  described  in  detail  in  considering 
diarrhoea,  q.  \'. 

Various  lesions,  acting  to  weaken  circulation  and  nutrition,  lead  to 
atony  of  the  bowel  muscles,  and  lead  to  constipation.  Any  lessening  of 
circulation  acts  to  cause  it,  as  the  circulation  of  blood  about  the  nerve 
terminals  in  the  bowel  wall  is  necessary  to  their  activity. 

The  Prognosis  is  good.  Most  cases  are  cured  in  a  reasonable  length 
of  time.  The  ordinary  acute  form,  occasional  constipation,  is  cured  in  one 
or  a  few  treatments.  Very  quick  results  are  often  obtained.  Cases  which 
have  been  most  obstinate,  and  those  that  have  been  from  birth,  ha\^e  been 
readily  cured.  Many  cases  are  obstinate  under  treatment,  and  require  time 
and  patience  to  effect  a  cure. 

The  Treatment  for  constipation,  from  the  nature  of  the  case,  must  look 
to  the  correction  of  the  lesion  that  is  obstructing  circulation,  peristalsis,  or 
secretion  in  the  bowel,  or  to  the  removal  of  the  mechanical  stoppage  that 
sometimes  causes  the  disease.  Some  one  or  more  of  the  special  lesions 
described  is  found,  and  may  be  removed  by  the  appropriate  methods.  The 
main  treatment  i_s  for  nerve  supply,  as  practicall)'  all  of  the  lesions,  except 
mechanical  causes,  act  in  one  way  or  another  through  the  innervation.  The 
main  treatment  upon  the  spine  is  in  the  lower  dorsal  and  lumbar  regions, 
the  seat  of  the  chief  lesions.  The  removal  of  the  lesion  is  often  all  the 
treatment  necessary,  but  various  points  must  be  considered.  The  treatment 
must,  by  the  remox^al  of  lesion  or  otherwise,  tone  the  splanchnics,  spinal 
sympathetics,  and  solar  plexus,  as  well  as  Auerbach  and  Meissner's  plex- 
uses, controlling  the  motor,  secretory,  and  other  functions  of  the  bowels. 
Special  attention  must  be  given  to  lesion  at  the  points  mentioned  as  liable 
to  them  in  this  trouble. 

Abdominal  treatment  should  be  a  deep,  slow,  relaxing  treatment 
carried  along  the  course  of  the  bowel.  It  relaxes  all  the  tissues,  and  frees 
local  circulation,  affecting  also  the  local  nerve  distribution.  It  dwells  par- 
ticularly upon  those  portions  in  which  are  felt  the  aggregations  of  fecal 
matter,  releasing  the  tissues  about  them,  softening  and  passing  them  along. 
This  is  the  special  method  of  removing  obstruction  by  foreign  bodies,  such 
as  fruit  stones,  etc.  This  treatment  should  be  given  especially  to  the  caecal 
and  sigmoid  portions,  as  they  are  generally  full.  Attention  must  be  given 
to  raising  and   straightening    them    when  necessary.     This  may  be  done  in 


Q2  PRACTICE   AXD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

the  treatments  described  in  III  and  IV,  p.  36.  Likewise  the  colon  as  a 
whole  should  be  raised  and  straightened  to  relieve  kinking  at  its  flexures 
and  the  e\il  results  to  ner\es  and  blood  vessels  accuring  from  the  stretch- 
ing of  its  omenta  in  ptosis.  Spinal  work  and  the  correction  of  lesion  tones 
these  omenta  to  hold  in  position  the  replaced  organs. 

The  liver  should  be  thoroughly  treated  to  stimulate  the  flow  of  bile. 
By  the  rcmo\al  of  lesion,  by  treatment  to  its  spinal  connections  through 
the  splanchnics.  and  b\-  raising  the  8th  to  I2th  right  ribs,  this  is  in  part 
accomplished.  It  is  treated  at  the  abdomen,  as  are  the  gall  bladder  and 
bile  duct.      {V.  p.  36,  IX.  p.  37). 

The  inferior  mesenteric  ganglion  is  the  center  for  the  fecal  reservoir, 
and  should  be  treated  at  the  location  already  described.  The  vagi  ma)'  be 
treated  in  the  neck  to  aid  in  the  general  process.  The  coccyx  should  be 
straightened  as  the  case  requires.  (XX,  p.  13.)  A  contractured  sphincter 
should  be  dilated,  (p.  44).  Or  it  may  be  released  b)'  strong  inhibition  over 
the  fourth  sacral  nerves.  They  may  be  located  at  the  fourth  sacral  for- 
amina, just  to  the  side  of  and  below  the  bony  prominences  that  mark  the 
termination  of  the  sacral  canal,  and  which  may  be  easily  felt  beneath  the 
skin. 

Peritoneal  adhesions  ma)'  be  broken  up  gradually  by  deep  and  careful 
work  upon  the  bowel  at  their  site.  In  the  absence  of  pain,  or  as  it  disap- 
pears, the  treatment  ma)'  be  made  strong,  care  being  taken  not  to  set  up  in- 
flammation. 

Obstruction  from  volvulus  may  be  sometimes  oxercome  by  manipula- 
tion at  the  seat  of  the  obstruction  directed  to  the  straightening  the  bowel. 
This  requires  long  treatment  at  a  time,  and  much  care  and  patience. 

Symptomatic  cases  must  de  treated  in  conjunction  with  the  primary 
disease. 

The  use  of  cold  and  hot  drinks  before  breakfast,  rectal  injections,  cereal 
foods,  fruits,  regularity  in  habit,  and  exercise  are  all  helpful. 


CARARRHAL  ENTERITIS;  DIARRHOEA. 

Definitiom: — An  acute  inflammation  of  the  intestinal  mucous  mem- 
brane due  to  specific  spinal  lesions.  Diarrhoea  is  often  sxmptomatic  of 
other  diseases . 

Cases: — Lesions  were  found  as  follows:  ( i)  Tension  of  the  spinal  tissues 
from  the  3rd  to  lOth  dorsal.  (2)  Lateral  lesion  of  the  7th,  8th  and  9th 
dorsal  vertebrae.  (3)  9th  to  nth  right  ribs  depressed.  (4)  Right  nth  rib 
down  onto  the  12th;  4th  and  5th  lumbar  anterior;  spine  weak. 

Lesions  may  occur  an)-  where  along  the  splanchnic  area  and  along  the 
spine  as  low  as  the  coccyx.  The  most  important  lesions  effect  the  region  of 
the  lower  two  dorsal  and  the  lumbar  vertebrae.     The  nth  and  12th  ribs  on 


PRACTICE  AXD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  93 

each  side  are  sometimes  found  luxated,  most  often  downwards.  Lesion 
may  occur  at  the  2d  lumbar,  the  5th  lumbar,  to  the  innervation  of  the 
small  intestine  above  the  first  lumbar,  to  the  innervation  of  the  large  intes- 
tine from  the  ist  to  4th  lumbar,  to  the  cocc\x,  or  to  the  innonimates.  Lesions 
from  the  8th  to  12th  dorsal  and  ribs  ma\'  affect  liver  and  pancreas  to  aid 
the  diseased  condition. 

Anatomical  relations: — In  intestinal  diseases  as  in  stomach  diseases,  the 
importance  of  the  splanchnics  and  solar  plexus  must  be  borne  in  mind. 
The  former  contain  vaso  and  viscero-motors  to  the  intestines,  these  vaso- 
motors being,  according  to  Fliut,  among  the  most  important  in  the  body, 
innervating  the  immense  area  of  abdominal  vessels,  which,  when  fully  dilat- 
ed, are  said  to  be  able  to  accomodate  one-third  of  the  total  quantit)'  of  blood 
in  the  body  They  contribute  to  the  solar  plexus,  which  rules  sensation, 
motion,  secretion,  nutrition,  and  circulation  in  all  these  viscera.  Our  cor- 
rection of  circulation  in  these  cases  is  an  important  consideration.  Robinson 
shows  that  movements  of  the  intestines  are  largely  dependent  upon  the 
amount  of  blood  circulating  in  the  intestinal  walls.  For  these  reasons  lesions 
anywhere  along  the  splanchnic  region  may  produce  important  disturbances 
of  intestinal  secretions,  circulation,  or  motion,  all  of  which  ma}'  be  disturbed 
in  diarrhoea. 

The  whole  abdominal  sj-mpathetic  is  important  in  these  diseases. 
Stimulation  of  it  lessens  peristalsis;  stimulation  of  the  pueumogastric  in- 
creases peristalsis.  We  work  not  to  directly  stimulate  or  inhibit  either  of 
these  for  the  purpose  of  controlling  peristalsis,  but  to  remove  lesion  from 
them  as  it  produces  through  them  abnormalities  of  motion. 

Auerbach  and  Meissner's  plexuses  of  ner\"es  have  to  carr}-  on  gastro- 
intestinal secretion.  Auerbach's  is  a  motor  plexus.  The)'  lie  in  the  intest- 
inal walls,  and  may  be  directly  influencel  by  work  upon  the  abdomen,  but 
are  corrected  by  us  through  the  remo\-al  of  lesions  affecting  them  through 
their  sj'mpathetic  and  spina!  connections.  Lesions  to  them,  disturbing  both 
secretion  and  motion,  are  important  causes  of  diarrhoea.  Robinson  states 
that  the  inferior  mesenteric  ganglion,  upon  the  inferior  mesenteric  artery, 
located  from  externally  a  little  below  and  to  the  left  of  the  umbilicus,  in- 
nervate the  muscular  -vvalls  of  the  fecal  reservoir,  i.  e.,  the  left  half  of  the 
transverse  colon,  the  descending  colon,  and  the  sigmoid.  Spinal  lesion  to 
it,  through  its  connected  nerves,  is  acti\-e  in  production  of  diarrhoea. 

The  fact  that  afferent  sympathetic  fibres  pass  from  the  abdominal 
\'iscera  to  the  thoracic  sympathetic  cord  may  explain  the  occurence  of 
secondary  lesions  in  the  form  of  contractured  muscles  along  the  thoracic 
spine.  The  presumption  is  that  the)-  are  sensory  in  function,  and  if  so,  sen- 
sor)- fibres  for  the  abdominal  viscera  may  be  associated  with  them.  Ouain 
states  that  among  the  meduUated  fibres  passing  into  the  sympathetic  system, 
some  derived  from  spinal  nerves  are  sensory  fibres.     This   ma)'  be  the    ex- 


94  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

planation  why  inhibition  of  the  splanchnic  area  will  Stop  pain  in  thestomich 
or  intestines. 

All  these  various  facts  indicate  the  importance  in  diarrhoea,  of  spinal 
or  lower  rib  lesion,  from  the  6lh  dorsal  to  the  coccyx,  which  may  interfere 
with  the  spinal  connections  of  all  these  abdominal  sympathetics  and  derange 
their  functions. 

Our  most  important  treatment  is  given  from  the  lOth  dorsal  down,  in 
these  cases.  Lesions  in  this  lower  spinal  region  are  of  prime  importance 
in  causing  diarrhoea.  The  importance  of  the  lesion  to  iith  and  12th  ribs 
and  vertebrae,  and  to  the  upper  two  lumbar,  is  found  in  the  fact  that  nerve 
branches  from  the  lower  dorsal  and  upper  two  lumbar  pass  to  the  inferior 
mesenteric  ganglion,  shown  above  to  innervate  the  fecal  reservoir.  These 
branches  are  motor  fibres  for  the  circular,  and  inhibitor)'  fibres  for  the  longi- 
tudinal, muscle  fibres  of  the  rectum.  At  the  same  time  these  lower  dorsal 
and  upper  two  lumbar  nerves  send  branches  to  the  sympathetics  and  supply 
\aso-constrictor  fibres  to  the  abdominal  \essels.  The  motor  fibres  to  the 
longitudinal,  and  inhibitory  fibres  to  the  circular,  muscle  fibres  of  the  rectum 
are  sent  from  the  sacral  nerves.  This  explains  why  the  lesion  of  the  in- 
nominate or  cocc)  X  may  cause  a  part  of  the  trouble  in  diarrhoea,  also  why 
strong  stimulatfon  to  the  sacral  nerves  relieves  tensmus. 

Branches  from  the  four  lumbar  ganglia  go  to  the  plexus  upon  the  aorta, 
and  to  the  hypogastric  plexus.  Lesion  in  the  lumbar  region  may  in  this 
way  further  interfere  with  the  bowel. 

The  various  forms  of  enteritis  and  diarrhoea  seem  to  have  as  their  basis 
derangement  of  nerve  or  blood  supply  in  the  form  of  infl  immation  (catarrh) ; 
lack  of  proper  vaso-inner\ation,  leading  to  congestion  and  exudation;  im- 
proper preparation  of  digestive  fluids,  due  to  deranged  glandular  activity; 
or  increased  peristalsis,  accompanied  b)-  increased  secretion  and  exudation. 

The  remo\al  of  lesion  obstructing  ner\e  and  blood  suppl)'  corrects 
the«e  manifestations  of  such  derangement. 

The  Prognosis  is  good.  Most  cases  of  diarrhoea  are  checked  at  once 
by  a  single  treatment,  man}'  needing  no  further  treatment.  Cases  of  years' 
standing  ha\e  been  in  many  instances  cured  in  a  short  time.  The  ordinary 
acute  diarrhoea  needs  but  one  or  a  few  treatments.  Acute  enteritis  needs 
careful  treatment  for  several  da)-s  while  the  acute  pocess  lasts. 

Teatment  for  diarrhoea  consists  in  the  removal  of  lesion  as  found,  af- 
fecting any  of  the  special  points  named  above  as  subject  to  lesion  in  this 
disease.  The  main  treatment  aside  from  this  is  very  simple,  and  is  often 
given  as  the  sole  measure  of  relief.  It  consists  of  very  strong  inhibition  of 
the  spine  from  the  lower  dorsal  to  the  sacrum.  It  may  be  given  with  the 
patient  on  his  side,  as  described  in  III,  p.  9.  The  "breaking  up"  spinal 
treatment  may  be  used  for  the  same  purpose.  (XXII,  p.  11).  The  former 
seems  preferable.  It  may  be  applied  to  either  side  or  to  both  sides  of  the 
spine. 


PRACTICE  AND  APPLIPJD  THERAPEUTICS  OF  OSTEOPATHY.  95 

Inhibition  may  be  made  at  the  nth  and  i2th  dorsal  region  by  sitting 
the  patient  upon  a  stool,  pressing  the  knee  against  the  spine,  first  on  one 
side  then  upon  the  other,  and  grasping  the  arms  of  the  patient,  raising  them 
above  his  head,  and  bending  the  body  backwards  against  the  knee.  This 
not  only  inhibits  these  nerves,  but  stretches  all  the  anterior  spinal  parts  and 
related  tissues  in  the  lower  dorsal  and  upper  lumbar  regions.  This  result  is 
more  important  than  the  mere  inhibition.  The  nth  and  12th  ribs  are  often 
displaced  downward,  and  may  then  drag  portions  of  the  diaphragm  in  such 
a  manner  as  to  prevent  free  circulation  of  blood  and  lymph  in  the  vessels 
perforating  it.     This  result  alone  might  cause  diarrhoea. 

Muscular  contractures  along  the  spine  should  be  removed.  Deep  but 
careful  manipulation  should  be  made  upon  the  abdomen  over  the  intestines 
for  the  purpose  of  relaxing  all  their  tissues,  freeing  circulation  and  correct- 
ing the  activities  of  the  Auerbach  and  Meissner's  plexuses.  One  may  treat 
to  tone  the  solar  plexus,  splanchnics,  and  general  abdominal  circulation. 
The  liver  should  be  thoroughly  treated,  lesion  to  it  be  removed,  and  the 
secretion  of  bile  corrected.  Its  presence  in  abnormal  quantities  may  cause 
biarrhoea  through  increasing  peristalsis.  In  other  cases  its  presence  in  the 
bowel  does  not  hinder  the  cast,.  And  it  is  said  to  allay  irritition  of  the 
mucosa.  Lesion  of  the  8th  to  12th  dorsal  and  ribs  may  derange  either  liver 
or  pancreas,     In  fatty  diarrhoea  the  latter  must  be  looked  to. 

For  tormina  or  griping,  inhibition  of  the  splanchnics  is  done.  For 
tenesmus,  or  bearing  down  pains  in  the  bowel,  strong  stimulation  of  the 
sacral  nerves  is  made  by  thorough  manipulation  of  the  tissues  over  the 
sacrum. 

It  is  said  that  in  such  cases  the  abdominal  fascia  is  contracted  and 
causes  congestion  mechanically.  (Chas.  Still)  When  contracted  it  should  be 
relaxed  by  abdominal  manipulation. 

The  vomiting  and  purging  should  not  be  checked  if  they  are  the  evid- 
ent means  of  getting  rid  of  the  irritating  contents  of  the  bowel.  The  or- 
dinary case  is  seen  after  plenty  of  opportunity  has  been  afforded  nature  to 
remove  the  irritant  by  these  means,  and  calls  for  immediate  checking. 

In  acute  enteritis  the  case  must  be  seen  several  times  daily.  Gentle  re- 
laxing treatment  should  be  made  over  the  abdomen.  The  liver  is  to  be 
lightly  treated;  spinal  muscles  relaxed;  the  spine  gently  sprung  to  release 
tension  in  its  tissues.  The  lower  ribs  may  be  raised  a  little  and  the  neck 
treated  for  relief  of  the  head.  Careful  attention  must  be  given  to  the  diet 
of  the  patient  It  should  be  light  and  restricted,  Meat  broths,  mucilaginous 
drinks,  etc.,  may  be  given  according  to  prescribed  dietaries.  Warm  baths 
and  rectual  injections  may  be  employed. 

Cases  of  acute  diarrhoea  and  enteritis  should  remain  quietly  in  bed. 
The  various  measures  described  may  be  employed  as  necessary.  Spinal  in- 
hibition alone  may  be  sufficient.  When  diarrhoea  is  s\'mptomatic  of  other 
disease  it  may  be  relieved  by  these  treatments.  Its  cure  depends  upon  the 
cure  of  the  disease  present. 


96  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


AN  OSTEOPATHIC  STUDY  OF  THE  DIAPHRAGM,  ITS  RE- 
LATION TO  ABDOMINAL  DISEASE 

(Prepared  for  "The  American  Osteopath,"  Dec.  '99.) 
'•The  diaphram.  next  to  the  heart,"  says  McClellan,  "is  the  most  extra- 
ordinary muscular  arrangement  in  the  body."     Standing  as  a  partition  wall, 
or  barrier  between  the  thoracic  and  abdominal  cavities  of  the    body;  being 
practically  an  involuntary  muscle,  and,  like  the    heart,  in    constant    motion 
throughout  life  ;    assisting  in    many    important    functions    of  life,    such    as 
breathing,  laughing,  coughing,  sneezing,  vomiting,  defecation    and    parturi- 
tion, yet  at  the  same  time  being  a  subsidiary,  and  not  always  an  indispensi- 
ble  agent  m  the  performance  of  these  functions,  it  takes  its  place  at  once  as 
somewhat    of  a    physiological    anomaly    among    the    organs  of  the    body. 
^Arising  by  fleshy  digitations  from  th^   cnsiform    cartilage,  from    the    inner 
surfaces  of  the  lower  six  ribs  on  either  side,    from    the   ligamenta    arcuata 
externa  et  interna,  and  by  its  crura  from  the  bodies  of  the  upper  four  lum- 
bar \ertebra  ;  sweeping  upward  as  a  broad  arch  to  its  insertion,  by  its  inter- 
I  lacing  fibres,  its  own  club-shaped  central  tendon,  it  forms  a    musculo  mem- 
braneous sheet  without  counterpart  in  the  body,    and   which    further    bears 
out  the  claim  of  this  remarkable  structure  to  be  an  anomal\',  anatomical  as 
well  as  phjsilogical. 

To  the  Osteopath,  since  Dr.  Still's    declaration    that    downward    luxa\ 

Itions  or  dislocations  of  any  of  the  lower  ribs  might  cause  such  an  altera-1 
tion  in  the  arch  of  the  diaphragm  as  to  allow  of  a  binding  of  its  substance 
upon  the  aorta  at  its  passage  between  the  crura,  thus  obstructing  the  blood 
current  and  leading  to  irregular  heart-action,  the  diaphragm  has  become  an 
important  object.  Astudyof  the  diaphragm,  therefore,  in  the  light  of 
Osteopathic  experience  with  the  musculature  of  the  body,  and  its  innerva- 
tion and  blood-supply,  and  an  application  of  well-known  Osteopathic  prin- 
ciples to  the  subject,  would  seem  tp  be  in  place. 

In  other  parts  of  the  body  the  Osteopath  makes  much  of  muscular 
contractures  or  ajftony,  of  their  interference  with  blood  vessels  and  nerves, 
of  mechanical  derangements  or  dislocations  of  organs  and  tissues.  May 
he  not,  then,  apply  such  reasoning  to  the  diaphragm,  which  occupies  an  im- 
portant position,  aids  in  carr\  ing  on  important  functions,  and  is  related  me- 
chanically to  organs,  vessels,  and  nerves  whose  functions  are  concerned 
with  the  most  vital  operations  of  the  body?  The  importance  of  this  sub- 
ject becomes  at  once  apparent  when  it  is  recalled  that  upon  one  hand  the 
diaphragm  is  contiguous  to  the  heart  and  lungs,  that  upon  the  other  it  is 
related  to  the  liver,  stomach,  pancreas,  kidneys,  spleen  and  intestines, 
while  it  transmits  to  and  from  the  abdomen,  such  important  structures  as 
the  aorta,  inferior  \ena  cava,  oesophagus,  thoracic  duct,  vena  az)gos  major, 
\ena  azygos  minor,  pneumogastric  nerves,  phrenic  nerves,  splanchnic  nerves, 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  97 

and  small  blood  and  lymphatic  vessels.     To  all  of  these  structures  it  bears,, 
direct!)'  or  indirectly,  a  mechanical  relation. 

Byron  Robinson  is  authority  for  the  statement  that  "traumatic  muscu- 
lar action  of  the  psoas  magnus  on  the  sigmoid,  and  traumatic  muscular  ac- 
tion lower  right  limb  of  the  diaphragm  on  the  descending  colon,  which 
muscular  action  induces  emigration  of  pathogenic  microbes  to  the  serosa" 
may  cause  peritonitis.  Gowers  is  authority  for  the  statement  that  violent 
contractions  of  muscles  may  have  a  traumatic  action  upon  nerves  passing 
through^heir  substance  or  beneath  or  around  them.  If  these  things  be 
true,  it  is  reasonable  to  suppose  that  the  diaphragm  might,  when  abnormal 
in  action,  unfavorably  affect  the  structures  to  which  it  is  so  closely  related. 
If  it  be  possible  for  the  psoas  magnus  and  the  right  crus  to  so  act  as  to  irri- 
tare  or  wound  a  contiguous  structure  so  freel\'  mobile  and  so  well  lubrica- 
ted as  is  the  sigmoid  or  the  descending  colon,  it  would  also  seem  possible 
that  conditions  could  arise  under  which  the  diaphragm  would  wound  or 
irritate  the  thoracic  duct,  one  of  the  azygos  veins,  the  oesophagus,  or  the 
aorta,  all  of  which  are  more  closel)'  related  to  the  diaphragm  than  is  the 
sigmoid  to  the  psoas  magnus,  or  the  descending  colon  to  the  crus,  as  they 
are  less  mobile  and  lack  lubrication.  If,  as  Gowers  says,  it  be  possible  for 
violent  muscular  action  to  wound  nerves  impinged  upon  b}'  muscles,  it 
would  also  seem  possible  that  the  diaphram,  when  in  violent  action,  as  in 
hiccough,  might  irritate  the  pneumogastrics  phrenics,  or  the  splanchnics. 
It  is  a  well-known  fact  one  of  much  significance  to  the  Osteopath,  that 
the  voluntary  muscles  of  the  body  are  capable  of  entering  into  a  state  of 
continued  contraction  tech'o^call)'  known  as  tetanus,  and  that,  as  Kirke 
states,  while  this  term  is  not  applied  to  involuntary  muscles,  they  likewise 
are  often  thrown  into  a  condition  pi  unduly  protracted  contraction,  known 
as  tonus.  The  causes  of  such  conditions  are  \'arious,  the  different  authori- 
ties pointing  out  that  the)'  may  arise  as  the  results  of,  (a)  constant  irrita- 
tion, affecting  either  nerve  or  center,  (b)  traumatism,  the  result  of  direct 
force  upon  the  muscle,  as  a  blow,  strain,  etc.,  (c)  disease  of  the  muscle,  (d) 
loss  of  antagonism,  or  excess  use.  The  Osteopath  la)'s  great  stress  upon 
the  potency  of  such  conditions  to  act  as  mechanical  interferences  and  to 
cause  disease  of  various  kinds.  Such  reasoning  applies  as  well  to  the  dia-^ 
phragm  as  to  an)-  other  muscle.     The  motor  nerves  of  the    diaphragm   are 

fthe  phrenics  and,  according  to  McClellan,  branches  from  the  lower  five  or 
six  intercostal  nerves,  which  are  reinforced  by  S)  mpathetic  fibres  from  the 
neighboring  supra-renal  plexuses.  The  phrenics  or  intercostals,  as  our~ 
daily  experience  shows,  may  be  irritated  by  spinal  lesion  at  their  origins, 
such  lesion  acting  upon  the  nerve  either  directly  or  indirectly,  through  its 
connected  nerves,  its  blood-supply,  or  its  center.    The  intercostals  may  alsa 

^e  irritated  by  crowding  together  of  the    ribs,    and    just    as   such    irritatibn 
may  cause  intercostal  neuralgia,  when  affecting  the  sensor)'  function  of  the 


98  PRACTICE  AND  AF'PLIED  THERAPEUTICS  OF  OSTEOPATHY. 

nerve;  it  may  produce  contracture    of  the    diaphragm    and   other    musclca 
when  affecting  the  motor  function. 

Such  a  condition  might  be  set  up  in  the  diaphragm,  as  in  other  muscles, 
by  traumatism,  or  the  result  of  force  directed  upon  the  diaphragm.  As  a 
blow  or  strain  ma)-  contracture  spinal  muscles,  so  the  direct  traumatic  effect 
of  an  enlarged  liver  or  spleen,  or  of  a  distended  stomach,  or  of  an  accumula- 
tion of  pus  or  other  fluid  in  the  pleural  cavit)'  may  so  irritate  the  muscle 
direct])  as  to  result  in  tonus. 

Loss  of  antagonism,  too,  would  seem  as  potent  in  this  situation  as  in 
any  other,  to  cause  contracture  of  the  muscle.     Just  as  a  dislocated    hip    is 

"Hield  out  of  place  through  contracture  of  muscles,  the  normal  antagonism 
to  which  has  been  destrosed  by  the  displacement,  so  may  tonus  or  contrac- 
ture of  the  diaphragm   follow  loss  of  antagonism.     Those    muscles    which 

'raise    and    spread  the  ribs  in  inspiration,  and  maintain  the  full  form  of  the! 

'  thora.x,  particularly  the  levatores  costarum  and  the  intercostales,  are  thej 
natural  antagonists  of  the  diaphragm.  We  are  all  familiar  with  the  antero- 
posterior flattening  of  the  chest  in  the  paralytic  or  the  neurasthenic,  with 
the  lateral  flattening  of  the  thorax  in  rachitis,  and  with  the  multitudes  of 
cases  in  which  all  the  ribs,  or  many  of  them,  are  dropped  down  and  drawn 
close  together.  When  for  an\-  reason  this  change  in  the  position  of  the 
ribs  and  in  the  diameters  of  the  thorax  has  taken  place,  then  the  agents 
which  have  held  the  ribs  apart  and  raised  them,  thus  keeping  well  separat- 
ed the  points  of  attachment  of  the  diapragm,  have  ceased,  in  greater  or  less 
measure,  to  operate,  perfect  antagonism  to  the  action  of  the  diaphragm  no 
longer  exists,  and,  following  the  rule  that  a  muscle  whose  points  of  attach- 
ment have  been  approximated  contracts  to  accommodate  itself  to  the 
changed  conditions,  the  diaphragm,  it  would  seem,  contracts  to  adjust  itself 
to  the  limits  set  for  it  by  the  narrowed  thorax,  and  is  thus  allowed  to  as- 
sume an  unnatural  condition  of  tonus  which  bodes  ill  to  the  free  play  of 
the  many  important  structures  passing  through  it. 

If  it  be  reasoned  that  the  nature  and  function  of  the  diadjragm  would 
not  admit  of  the  existence  of  such  a  condition  of  its  muscular  substance,  it 
being  an  involuntar}-  muscle  performing  rhythmic  motion  continually  which 
is  well  nigh  indispensable  as  an  aid  to  vital  functions,  and  that  these  func- 
tions seem  to  be  carried  on  without  apparent  embarrassment  even  when  all 
the  untoward  conditions  pointed  out  abo\e  seem  to  exist,  let  it  be  remem- 
bered that  in  other  parts  of  the  body  we  ha\e  important  involuntary  mus- 
cular organs,  also  in  rhythmic  action  almost  continually,  and  more  indis- 
pensible  than  is  the  diaphragm  to  certain  vital  operations,  which  are  well 
known  to  become  the  seat  of  tonus  or  contracture,  even  while  still  perform- 
ing their  functions.  I  refer  to  the  intestines.  Ever)-  Osteopath's  experi- 
ence with  abdominal  work  will  teach  him  that  at  times  there  are  in  the  in- 
testines more  or  less  extensive  areas  of  tonus,  in  which  the  walls  of  the 
bowel  become  so  drawn  as  to  be  clearl)-  perceptible  to  the    touch.     Such  a 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATH\^  99 

spasmodic  action  of  the  muscles  takes  place  in  an  acute  form  in  colic.  The 
functions  of  the  intestines  may  still  be  carried  on  under  such  conditions, 
though  it  be  with  pain  and  dif^culty. 

[         In  gross  displacement  of  the  ribs,  as  best  seen  in  the  enormous  change^, 
;in  position  that  may  affect  the  eleventh  and  twelfth    rib>,  it    is    likely    that  \ 
there    is    a  dragging  upon  special  fibres  or  portions  of  the  diapragm.     The  | 
.central  tendou  is  held  in  place  by  the  attachment  to  the    pericardium,  and   ' 
jby  the  lateral  bands  extended  downward  from  the  deep  cervical  fascia.     If, 
nows  one  or  several  lower  ribs  be  displaced  dowoward,  the  portions   of  the 
(diaphragm    attached    thereto    would  be  carried  downward,  causing  traction 
upon  them,  and  perhaps  drawing   them   across    an    important    structure,   it 
jmight  be  the  aorta,  impeding  its  blood  current,  or  the  splanchnics,  interfer- 
Cing  with  their  function. 

If  these  views  are  correct,  it  is  apparent  at  a  glance  what  harm  might 
be  caused  b)-  such  interference  with  the  structures  passing  through  the  dia- 
phragm. In  such  case  it  seems  that  the  inferior  vena  cava  and  the  struc- 
tures passing  through  the  oesphageal  opening  would  suffer  least  through 
impingement,  since  the  former  passes  through  a  fibrous  portion,  which  is 
naturally  less  yielding,  and  the  shape  of  the  aperture  is  maintained  by  at- 
tachment of  the  wall  of  the  inferior  vena  cava  to  the  central  tendon,  while 
the  oesophagus  and^pneumogastric  nerves,  though  surrounded  b\'  the  upper 
part  of  the  eight-sj^aped  arrangment  of  the  muscular  crura,  are  protected 
by  the  yielding  character  of  the  oesophagus,  which,  when  not  occupied  by 
the  passage  of  food  or  drink,  is  merely  a  potential  cavity,  its  walls  lying  in 
apposition. 

The  aorta,  however,  surrounded  by  the  crura 'of  the  diaphragm  upon 
both  sides  and  anteriorly,  and  by  the  bony  spinal  column  behind,  would,  to- 
gether with  the  vena  azygos  major  and  the  thoracic  duct,  be  subject  to  serious 
pressure  from  contracture.  This  is  on  account  of  the  muscular  nature  of 
the  crura,  the  unyielding  spine  behind  the  aorta,  and  the  fact  that  the  aorta, 
to  fulfil  its  function,  must  have  walls  resistent  enough  to  maintain  its  form. 
Moreo\er,  the  walls  of  the  aorta  are  supplied  b}'  delicate  sympathetic 
nerve  fibres  which  are  very  susceptible  to  irritation.  The  sympathetic  and 
splanchnic  nerves,  and  the  vena  az)'gos  minor,  transmitted  by  the  crura, 
and  the  phrenic  nerves,  which  perforate  the  substance  of  the  diaphragm, 
would  all  likewise  suffer  from  pressure  and  irritation  through  contracture 
or  dragging  of  its  fibres. 

In  the  consideration  of  the  pathology  of  the  diaphragm  there  is  another 
matter  which  invites  our  attention,  namel}':  atony  of  its  muscular  fibers.  If 
the  diaphragm  is  like  other  muscular  organs  there  can  be  no  doubt  that 
such  a  condition  might  occur.  We  are  acquainted  with  the  condition  known 
as  aton)'  of  the  bowel,  or  of  the  stomach,  and  with  the  serious  consequences 
of  such  a  pathological  change.  i 

It  is  a  well-known  fact  that  section  of  a  motor  nerve  is  followed  by  loss 


100  PRACTICE  AND  APPLIED  THERAPEUTICS  OF   OSTEOPATHY. 

of  nutrition  in  the  muscles  supplied  b)'  such  nerve.  We  are  also  familiar 
with  the  fact  that  pressure  upon  a  motor  nerve  leads  to  wasting  of  the  mus- 
cles supplied  by  that  nerve.  Hilton  reports  a  case  in  which  pressure  upon 
the  circumflex  nerve  by  the  head  of  a  dislocated  humerus  caused  atrophy 
of  the  deltoid  muscle.  Gowers  says  that  a  muscle  remains  small  after  lesion 
of  its  nerve.  Such  occurences  are  common  enough  in  our  practice.  Now 
it  is  a  reasonable  supposition  that  the  lower  six  ribs  might  be  so  crowded 
together  as  to  impinge  the  intercostal  nerves  supplying  the  diaphragm,  that 
pressure  upon  these  ner\es  would  be  followed  b)-  wasting  of  the  muscles 
supplied  b)'  them,  and  that  lack  of  tone  in  the  diaphragm  would  follow.  It 
is  also  quite  possible  that  derangement  of  cervical  vertebrae  would  so  inter- 
fere with  the  third,  fourth  and  fifth  cer\  ical  nerves,  from  which  the  phrenic 
ner\'es  arise,  as  to  contribute  to,  or  produce,  the  same  result.  Add  to  these 
facts  the  possibilities  of  various  interferences  with  the  lower  intercostal,  in- 
ternal mammary,  and  phrenic  arteries,  which  suopl)' blood  to  the  diaphragm, 
and  there  would  seem  to  be  sufficient  grounds  for  supposing  that  this  mus- 
cle can  not  be  immune  to  the  \arious  causes  that  would  lead  to  atony  of  its 
muscular  fibres. 

Here  is  fruitful  soil  for  evil.     \'er}-   possibl\'  hese  is    the  origin   of  erT^ 
teroptosis,  the  evil  consequences  of  which  have  been   so  well   portrajed   by 
Byron  Robinson.     Enteroptosis  is  a  neurotic  disease;  the   neurasthenic  is 
flat-chested;    the     lowered    ribs    in    the    flat-chested    allow    of    an    atonic 
diaphragm.     To  the  under  surface  of  the  diaphragm, by  the  various-  omenta, 
are  attached  the  liver,  the  stomach,  the    spleen,  and  the  splenic  flexure  of/ 
the  colon.      Following  atony  of  the  diaphragm, these  organs  sink  downward 
in  the  abdomen.     They  crowd  the  other    organs,    weight    them,    and    cause 
them  to  gravitate  downward.     The  colon   kinks  at  its  splenic  and   hepatic! 
flexures,  and  the  passage  of  its  contents  is  impeded.     The  dragging  of  the 
various  organs    upon    their  omenta  and  ligaments  causes  them  to  elongate, 
and  thus  stretches  the  blood-vessels  and   nerves  conveyed   in    them  to  thq 
abdominal  viscera,  in  short,  the  whole  blood   and  nerve   mechanism   of  the 
abdomen  is  deranged,  and  discord  reigns  in  the  family  of  abdominal  organs^y 

Another  ill  result  would  arise  from  an  atonic  diaphragm.  The  ordinary 
quiet,  abdominal  breathing  that  carries  on  respiration  generally,  would  suf- 
fer from  lazy  action  of  a  weakened  diaphram,  leading  to  poor  ox)genation 
of  the  blood  and  an  accumulation  of  waste  material  in  the  system.  The 
aspiration  of  the  venous  blood  through  the  li\er  and  other  abdominal  or- 
gans, which  is  effected  by  free  diaphragmatic  action  would  be  weakened  or 
lost,  leading  to  sluggishness  of  these  currents,  and  to  abdominal  conges- 
tion. 

It  would  be  well  for  the  Osteopath,  in  all  cases  in  which  there  is  altered 
chest  form,  luxated  lower  ribs,  irregular  heart  action,  general  nervousness, 
digestive  disturbance,  biliousness,  constipation,  and  other  abdominal  troub- 
les, etc.,  to  consider  well  whether  or  not  the  diaphragm  might  be  in  such  a 
condition  as  to  cause  or  aggravate  the  symptoms. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  lOl 

The  method  of  treating  the  diaphragm  in  such  contingencies  is  simple 
enough,  since  it  depends  upon  the  application  of  the  same  principles  as  are 
used  in  our  work  upon  any  muscle  or  organ  similarly  affected;  to  stmiulate 
or  inhibit,  or  to  remove  the  special  lesion  which  is  causing  the  mischief. 
There  are,  generally  speaking,  two  methods  of  relaxing  or  stimulating  mus- 
cles; (a)  through  affecting  their  nerve  connections,  (b)  through  affecting 
the  muscle  directly.  Either  or  both  of  these  ways  may  be  brought  into 
play  by  removal  of  lesion.  An  example  of  the  former,  in  relation  to  the 
diaphragm  is  seen  in  pressure  made  in  the  neck  upon  the  phrenic  nerve,  re- 
leasing the  spasm  of  hiccough.  An  example  of  the  latter  is  seen  in  a  meth- 
od employed  by  one  of  my  friends;  in  a  case  of  hiccougs,  after  trying  the 
usual  method  of  stopping  the  spasm,  he  inserted  the  fingers  beneath  the 
lower  ribs  on  either  side,  and  by  spreading  them  away  from  the  median 
plane  of  the  body,  brought  traction  directly  upon  the  diaphragm  by  sepa- 
rating its  points  of  attachment,  thus  relaxing  it  and  stopping  the  spasm. 
Ihe  same  principle  is  involved  in  Dana's  method  of  stopping  hiccough.  He 
lays  the  patient  upon  a  table  with  the  upper  half  of  the  body  hanging  over 
the  edge.  This  arches  the  thorax,  spreads  the  ribs  and  brings  tension  upon 
the  diaphragm,  inhibiting  the  spasm. 

But,  aside  from  hiccough,  there  are  important  considerations  for  the 
Osteopath  in  treatment  of  the  diaphragm  in  conditions  of  contracture  or 
atony  as  pointed  out  in  this  paper.  This  whole  question  was  suggested  to 
my  mind  by  the  remark  of  a  friend  that  my  lower  costal  treatment  first 
stimulated  the  diaphragm,  leading  to  clonicity,  which  was  soon  followed  by 
fatigue  of  its  muscular  fibres,  allowing  of  a  complete  relaxation  and  a  con- 
sequent freedom  of  all  structures  passing  through  it.  Of  the  correctness  of 
this  view  there  seems  to  be  no  doubt.  Naturally,  we  propose  to  repair 
atony,  contracture,  or  distortion  of  the  diaphragm  by  removal  of  the  lesion 
causing  it.  By  correcting  cervical  or  spinal  lesion,  by  shaping  a  narrowed 
thorax,  by  raising  and  replacing  dislocated  or  luxated  ribs,  and  by  separat- 
ing rips  when  crowded  together,  we  are  to  remove  the  active  and  original 
cause  of  such  conditions.  But,  aside  from  these  considerations,  in  cases  in 
which  it  is  desirable  to  affect  the  diaphragm  either  as  adjurant  to  the  re- 
moval of  lesion  or  independently  of  it,  in  such  cases  as  seem  to  need  extra 
stimulation  or  relaxation  of  the  diaphragm,  there  are  important  considera- 
tions for  its  treatment.  There  is  no  doubt  that  much  abdominal  and  lower 
costal  treatment  goes  much  further  that  the  operator  supposes  in  effecting 
the  body.  The  proposition  may  be  stated  as  follows:  Lower  costal  and 
abdominal  treatment  profoundly  affects  the  diaphragm,  (a)  It  stimulates 
and  strengthens  it  when  lacking  energy,  adding  to  it  that  force  and  tension 
so  necessary  to  a  perfect  performance  of  its  function.  At  the  same  time 
pneumogastrics  and  sympathetics,  thoracic  duct,  and  blood  vessels  are 
stimulated  in  their  action,  (b)  It  sets  up  clonicity  of  its  muscular  fibres, 
this  leads  to  fatigue  and  relaxation  of  its  fibres,  relaxes  the  contractured  con- 


102  PKACTICK  AND  APPLIED  THKRAPEUTICS  OF  OSTEOPATHY. 

tlition  of  the  whole  organ  and  allows  of  perfect  freedom  in  the  action  of  all 
structures  passing  through  it.  Which  one  of  these  affects  follows  depends 
upon  the  condition  of  the  diaphragm  to  begin  with,  and  upon  the  method 
of  treatment  adopted  by  the  operator. 

If  these  views    are   correct,  it  does  not  need  much    penetration    to   see 
that  such  treatment  must  necessarily  have  a  marked  effect  upon   the  health 

of  the  whole  bod\'. 

To  the  examination  of  this  proposition  let  us  again  appl\-  well  known 
principles  used  by  us  upon  other  parts  of  the  body.  Atony:  In  an  atonic 
or  lifeless  condition  of  the  bowels,  allowing  of  sluggish  performance,  or 
non-performance,  of  duty,  resulting  in  lessened,  or  lost,  peristalsis,  leading 
to  constipation,  etc.,  the  most  important  part  of  our  work  (aside  from  re- 
moval of  lesion,  which  is  also  left  aside  for  the  present,  in  the  consideration 
of  the  diaphragm),  is  direct  manipulations  upon  the  intestines,  stimulating 
their  substance,  and  the  blood  vessels  and  ner\es  contained  in  their  walls 
and  about  them.  Increased  vigor,  peristalsis,  follows.  Contracture:  In 
tormina  and  in  all  kinds  of  contracturing  or  drawing  of  the  intestinal  walls, 
our  mo.-^t  important  effects  in  relaxing  the  muscular  walls  are  attained  by 
direct  inhibiting  treatment  upon  the  intestines  (removal  of  lesion  aside). 
The  same  principles  apply  to  diaphragmatic  treatment.  With  us  it  is  an 
aphorism  that  muscles  and  nerves  may  be  stimulated  mechanically.  Wit- 
ness the  production  of  the  patellar  reflex,  or  our  abdominal  treatment  to  in- 
crease peristalsis.  This  point  must  be  supported  by  quotations  at  length 
from  authorities,  but  I  take  it  to  be  unnecessary  to  prove  this  point  again  to 
Osteopaths.  Suffice  it  to  quote  from  Howell's  Text  Book,  "'A  sudden  blow, 
pinch,  twitch,  or  cut  excites  a  nerve  or  muscle."  Neuro-muscular  contrac- 
tion follows  excitation  of  motor  nerves.  Idlo-muscular  contraction  follows 
excitation  of  a  muscle  directly.  Moreover,  Gowers  states  that  slow  tonic 
contractions  of  a  muscle  occur  when  its  points  of  attachment  are  suddenly 
approximated. 

Now  all  of  these  conditions  can  be  easily  applied  in  treatment  of  the 
diaphragm.  Both  idio-muscular  and  neuro-muscular  contractions  may  be  set 
up  in  it.  It  ma\-  be  directh' stimulated  mechanically  by  quick  abdominal 
manipulations  which  thrust  the  liver,  stomach, spleen  and  intestines  up  against 
itscuraand  vault.  It  may  be  stimulated  through  its  intercostal  nerves  by  the 
excitation  given  them  in  the  lower  costal  treatment,  which  squeezes  the  ribs 
too-cther  and  separates  them,  this  motion  as  well  slimulatmg  these  nerves 
through  their  spinal  connections  through  the  spring  given  to  the  ribs  at 
their  spinal  ends  by  such  manipulations.  In  addition  to  this,  the  costal  and 
abdominal  treatments,  by  approximating  the  ribs,  narrowing  the  lower 
thorax,  and  raising  the  abdominal  viscera,  result  in  suddenly  approximat- 
ing all  the  points  of  attachment  of  the  diaphragm,  which  must,  in  accord- 
ance v.ith  the  law  enunciated  by  Gowers.  enter  into  slow  tonic  contractions. 

Add  to  this,  now,  the  fact  that  by  removal  of  lesion  the  injured    nerves 


PRACTICE  AKD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  103 

may  be  restored,  resulting  in  the  muscle  regaining  its  nutrition.  Consider- 
ing the  above  points,  we  have  all  that  is  necessary  to  affect  the  repair  of 
the  diaphragm  in  aton\',  or  its  stimulation  in  all  cases  where  desirable. 

We  must  now  consider  the  removal  of  contracture  in  diaphragmatic 
treatment.  As  we  remove  abnormal  tonicity  in  the  intestinal  walls  by  deep 
pressure  and  inhibition,  directly  applied,  so  we  may  remove  it  in  the  dia- 
phragm by  direct  inhibition  of  its  substance.  This  may  be  accomplished 
in  several  ways.  It  has  already  been  pointed  out  that  spreading  of  the 
ribs  from  the  median  plane  of  the  body  brings  inhibition  upon  the  fibers  of 
the  diaphragm.  Here,  also,  deep  pressure  and  inhibition  may  be  di- 
rectly applied  by  firm  pressure  of  the  abdominal  contents  upward  against 
the  diaphragm. 

The  law  of  muscular  action  and  fatigue  affords  us  another  means  of  ef- 
fecting this  result.  If  we  consider  the  nature  of  muscular  action,  we  learn 
from  Howell's  Text  Book  that  all  normal  physiological  contractions  of 
muscles  are  regarded  as  tetani.  This  means  that  the  contraction  of  a  mus- 
cle as  a  whole  is  not  due  to  a  single  contraction  of  its  substance,  but  to 
many  succeeding  contractions  of  its  elements.  Repeated  excitations  lead 
to  a  gradually  increasing  state  of  contraction,  the  "stair-case  contractions" 
as  shown  by  Bowditch  upon  the  ventricle  of  frog's  heart.  Howell's  Text 
Book  shows  that  stimulations  of  a  muscle  once  in  about  e\  erv  two  seconds 
leads  to  an  incomplete  tetanus  of  the  muscle,  while  eight  to  thirteen  exci- 
tations per  second  can  cause  voluntary  tetani.  But  it  also  shows  that, 
"rapidly  repeated  stimuli,  though  at  first  fa\-orable  to  activity  of  a  muscle, 
soon  exert  an  unfavorable  influence  by  causing  the  lessened  irritability 
whi5(h  is  associated  with  fatigue."  "Mechanical  applications  to  nerxe  and 
muscle  first  increase  and  later  lessen  and  destroy  the  irritability.  Thus 
pressure,  gradually  applied,  first  increases  and  later  reduces  the  power  to 
respond  to  stimulants."  Hence  it  seems  that  the  Osteopath  would  be  able 
to  apply  to  the  diaphragm  mechanical  stimulation  frequently  enough  and 
continuously  enough  to  first  excite  and  contract  it,  and  later  fatigue  it,  lead- 
ing to  its  relaxation  and  the  consequent  freedom  of  all  structures  penetrat- 
ing it. 

Careful  attention  to  the  condition  of  the  diaphragm,  both  in  diagnosis 
and  in  treatment,  would  well  repa\'  the  Osteopath. 


/ 


|/H:fc.     S-^r^jOr    A-W      ....M-wU^  .  ^^^^  ^A^or^..-^-^.^      ^ 


^^^^^^"  'S^SrtSr^^ 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  10$ 


APPENDICITIS, 

Definition. — An  inflammation  of  the  vermiform  appendix,  acute  or 
chronic,  caused  by  traumatisin,  or  by  specific  rib  or  spinal  lesions,  These 
lesions  obstruct  bowel  action,  limit  its  motion,  deplete  its  nerve  and  blood- 
supply,  leaving  a  weakened  condition,  allowing  of  aggregation  of  fecal 
matter,  foreign  bodies,  etc.  The  vigor  to  pass  these  onward  is  lacking,  and 
they  are  pressed  into  the  appenpix,  which  itself  is  suffering  from  a  weaken- 
ed state  due  to  these  causes.  Or  direct  irritation  of  lesion  may  affect  nerve 
and  blood  mechanism,  derange  vaso-motion,  and  set  up  the  inflammation. 
Or  the  direct  mechanical  irritation  of  a  displaced  lower  rib  may  set  up  the 
inflammation. 

Cases:-— (i)  Three  attacks  had  occured,  another  one  was  threatening. 
Operation  had  been  advised,  but  osteopathic  treatment  relieved  at  once  and 
cured  the  condition  in  two  weeks.  (2)  In  a  case  in  which  operation  had 
been  advised,  one  month's  treatment  cured  the  condition  and  chronic  con- 
stipation as  well.  (3)  Case  showed  a  histor}'  of  constipation;  cured  by  the 
treatment.  (4)  Lesions;  2  I  lumbar  lateral,  with  heat  and  pain  about  it; 
nth  right  rib  luxated.  Treatment  relieved  at  once,  and  the  patient  was 
cured  in  two  weeks.  Surgeon  had  been  ready  to  operate.  (5)  12th  right 
rib  down  and  inside  of  the  crest  of  the  ilium.  Setting  the  rib  cured  the  case 
in  a  few  days  (6)  Recurring  appendicitis;  spine  posterior  in  lower  dorsal 
and  upper  lumbar;  lateral  curve  at  6th  to  9th  dorsal;  constipation  chronic; 
cured  by  ten  weeks'  treatment.  (7)  Tenderness  upon  right  side  of  spine 
from  6th  dorsal  to  2d  lumber,  especially  at  the  6th  to  loth  dorsal  and  ist 
and  2d  lumbar.  (8)  Acute  attack  cured  by  the  treatment,  (9)  Lesion  at 
lower  dorsal  and  upper  lumbar;  loth  and  nth  ribs  overlapping  12th,  due  to 
a  fall.  Operation  had  been  atlvist  d,  but  two  months'  treatment  cured  the 
case. 

Lesions a)id causes: — (i)There  is  usually  a  histor\- of  constipation  in  these 
cases.  In  some  it  follows  diarrhoea.  There  can  be  no  doubt  that  the  lesions 
causing  these  diseases,  q.  v.,  are  the  real  causes  of  appendicitis  in  many  cases. 
Many  apparently  robust  men  suffer  from  this  disease,  but  experience  shows 
that  many  such  have  unhealthy  bowels  to  begin  with.  Many  show  the 
specific  spinal  lesion.  The  ordinary  case  caused  by  a  foreign  body,  seeds, 
shot,  enteroliths,  etc.,  would  probaby  not  become  victims  of  appendicitis 
but  for  weakened  bowel  condition  due  to  such  lesions  as  cause  constipation. 
The  fact  that  very  often  the  body  is  a  fecal  concretion  supports  this  view. 
The  inflammation  is  a  vaso-motor  disturbance.  Such  disturbances,  due  to 
lesion,  have  been  seen  to  be  the  causes  of  constipation,  etc.  The  appendix 
must  suffer  with  the  rest  of  the  bowel  from  these  causes,  and  thus  being 
weakened  cannot  further  resist  special  causes  of  vaso-motor  disturbance. 

(2)  Displacement,  or  dragging  of  the  colon  at  the  hepatic   flexure  pre- 


106  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

vents  the  passage  of  fecal  matter  and  forces  the  introduction  of  fecal  masses 
into  the  appendix. 

(3)  The  most  important  bony  lesions  seem  to  be  displacements  of  the 
lower  two  ribs  on  the  right  side.  They  may  add  mechanical  obstruction  or 
irritation  to  deranged  nerve  connections  at  the  spine. 

(4)  Lesions  of  the  dorsal  and  lumbar  regions  are  very  important  on  ac- 
count of  the  nerve  connections  with  the  bowel.  From  the  9th,  loth,  nth 
and  1 2th  dorsal  region  sensory  nerves  pass  through  the  sympathetics  to 
supply  the  intestines  down  to  the  upper  part  of  the  rectum.  For  this  rea- 
son strong  inhibition  to  this  portion  of  the  spine  is  useful  in  controlling  the 
pain  in  appendicitis.  The  s)mpathetic  vaso-constrictor  fibres  for  the  ab- 
dominal vessels  pass  from  the  lower  dorsal  and  upper  two  lumbar  nerves, 
whiel  branches  from  the  lumbar  ganglia  pass  to  the  plexus  upon  the  aorta 
and  to  the  hypogastric  plexus.  Thus  lower  dorsal  and  lumbar  lesion  has 
an  important  effect  in  disturbing  the  vaso-motor  innervation  necessary  to 
the  production  of  this  inflammation. 

The  anatomical  relations  given  for  lesion  in  diarrhoea  apply  to  those 
in  appendicits. 

The  appendix  has  the  same  structure  as  the  caecum,  practically;  is  nour- 
ished b)'  a  branch  of  the  ileo-colic  arter)',  possesses  innervation  (Auerbach 
and  Meissner's  plexus?)  causing  in  it  peristalsis  and  secretion  of  abundant 
tough  mucous  from  its  numerous  mucous  glands.  In  health  the  free  secre- 
tion of  this  mucous  fills  the  caviy  of  the  structure  to  the  exclusion  of  foreign 
bodies,  but  upon  lesion  to  the  blood  or  nerve  supply  such  as  mentioned 
above,  lessened  secretian  allows  of  room  for  the  entrance  of  foreign  bodies. 
Anemia  may  become  a  cause  of  the  inflammation  in  it. 

The  Prognosis  is  favorable  for  recovery  in  nearly  all  cases.  The  ex- 
perience with  cases,  even  the  most  dangerous  acute  ones,  has  been  very  sat- 
isfactory. Man\-  such  are  upon  record,  restored  to  health  after  operation 
had  been  advised  as  the  last  resort.  If  seen  in  time,  very  few  cases  need 
ever  come  to  the  knife.  The  point  of  surgical  interference  may,  however, 
be  reached.  Osteopathic  treatment  prevents  the  case  falling  into  the  chronic 
forms  so  commonl)-  met,  and  in  which  operation,  to  prevent  an  acute  at- 
tack, is  £0  often  resorted  to.  The  acute  case  is  usually  aborted  by  prompt 
treatment. 

Treatment: — The  first  consideration  is  the  removal  of  the  lesion  if  pos- 
ible  in  the  patient's  condition.  This  applies  particularly  to  displacements 
of  the  nth  and  12th  ribs.  Here  gentle  manipulation  and  slight  elevation 
may  be  sufficient  to  remove  the  irritation.  Immediate  attention  should  also 
be  given  to  the  relief  of  the  constipation  commonly  present.  If  not  soon 
affected  by  the  treatment,  rectal  injection  should  be  employed.  This 
measure  materially  aids  conditions  b)'  removing  the  pressure  of  bowel  con- 
tents from  tender  points,  b}'  giving  freedom  of  circulation  in  the  bowel,  and 
by  aiding  to  remove  foreign  bodies. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV.  10/ 

An  essential  part  of  the  treatment  is  local  treatment  of  the  tissues  at  or 
above  the  site  of  the  inflammation.  By  care,  little  difficulty  will  be  experi- 
enced in  applying  such  treatment  even  in  very  painful  cases.  The  relaxa- 
tion of  the  tissues  thus  accomplished  gives  immediate  relief  to  the  patient. 
Not  only  the  abdominal  walls,  but  the  deep  tissues  and  circulation  about  the 
appendix  are  thus  treated.  The  treatment  must  slow,  deep,  and  inhibitive 
and  given  with  great  care,  In  the  intervals  of  treatment,  it  may  be  neces- 
sary to  apply  the  ice  bag  or  hot  fomentations  at  the  seat  of  the  inflamma- 
tion. 

It  is  not  likel)'  that  in  this  contingency  spinal  work  to  increase  perista- 
lsis would  be  at  all  successful  in  removing  the  foreign  body  from  the  ap- 
pendix. Local  manipulation  must  be  depended  upon  for  this.  The  pain 
is  relieved  by  spinal  inhibition  from  the  gth  to  the  1 2th  dorsal  particularl)'. 
Nausea,  vomiting,  fever,  and  hiccough,  aside  from  being  relieved  by  the 
general  trertment  of  the  case,  may  be  relieved  by  the  usual  methods  before 
described. 

The  patient  should  go  to  bed  at  once  upon  the  attack  threatening.  A 
restricted  fluid  diet,  taken  a  little  at  a  time,  should  be  enforced.  Attention 
should  be  given  the  kidneys  and  general  condition.  The  patient  should  be 
seen  several  times  daily  until  out  of  danger.  Continued  treatment  should 
be  given  for  a  while  after  recovery  to  prevent  recurrence  or  relapse. 

The  chronic  case,  possessing  various  degrees  of'chronic  pain,  tenderness 
of  tissues,  and  inflammation  in  the  right  iliac  fossa  is  a  familiar  object.  The 
object  of  the  work  is  to  remove  lesion,  to  restore  perfect  freedom  of  circula- 
tion, and  by  local  treatment  of  the  tissues  to  remove  tenseness  and  pain. 
Thorough  spinal  and  abdominal  treatment,  and  attention  to  the  general 
condition  of  the  bowel  are  necessary.  The  disapperance  of  tenderness  in 
the  right  iliac  fossa  does  not  remove  the  danger  of  acute  attack,  as  extensive 
morphological  changes  have  usually  taken  place  in  the  tissues  of  the  ap- 
pendix which  call  for  a  course  of  treatment  to  so  restore  circulation  as  to 
enable  it  to  repair  them. 


IN  TESTINAL^OBSTRUCTION. 

Definition: — The  occlusion  of  the  bowel  ma\'  be  but  partial,  persist- 
ing as  a  chronic  condition.  In  acute  cases  it  ma)'  be  wholly  or  partiall}' ob- 
structed. 

Cases:  (i)  Fecal  impaction.  Severe  radiating  abdominal  pains, 
griping,  and  some  dj'sentery  had  been  present  for  twenty-four  hours.  The 
impaction  was  located  at  the  hepatic^flexure.  Treatment  relieved  the  pain 
at  once,  and  the  manipulation  removed  the  obstruction.  Complete  recov- 
ery followed. 

(2)     Volvulus  was  diagnosed,  located  near   the  ilio-caecal    valve.     The 


I08  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

surgeon  was  ready  to  operate.   Persistent  treatment  straightened  the    bowel 
and  a  movement  of  the  bowels  was  had.     The  recovery  was  complete. 

(3)  Impaction  of  the  ileo-caecal  valve.  The  attack  came  on  violently 
at  night.  The  family  physician,  after  eighteen  hours'  work  over  the  patient 
advised  operation.  Osteopathic  treatment  reduced  pain  and  inflammation 
at  once,  and  allowed  a  further  examination.  The  impaction  was  located  at 
the  ileo-caecal  valve,  and  manipulation  removed  it  within  a  short  time.  Tlie 
patient  was  asleep  in  thirty  minutes. 

Lesions  and  Causes:  Only  in  rare  cases  would  it  be  likely  that  some 
specific  lesion  would  lead  directly  to  this  trouble,  but  in  most  of  them  it  is 
probable  that  lesions  would  be  present  accounting  for  the  bad  condition  of 
the  bowel  that  resulted  in  some  form  of  obstruction.  In  general  one  would 
expect  such  lesions  as  have  alread>-  been  described  as  interfering  with  the  ab- 
dominal organs.  Intussusception  is  sometimes  due  to  irregular,  limited, 
sudden,  or  severe  peristalsis.  In  such  cases  special  lesion  to  the  splanch- 
nics,  or  to  the  sympathetic  connections  of  Auerbach's  plexus.'might  result 
direcll)-  in  the  abnormal  paristalsis  producing  the  invagination.  In  such 
cases  the  outer  la\er,  or  receiving  portion  of  the  bowel  involved,  draws  up 
by  contraction  of  its  longitudinal  fibers.  Such  abnormal  activity  of  these 
fibers   might  also  be  due  to  some  special  lesion  to  motor  inner\'ation. 

In  some  cases  McConnell  suggests  that  special  spinal  lesion  could 
cause  paresis  or  paralysis  of  a  bowel  segment.  Such  a  condition  could  al- 
low of  a  pouching  of  the  affected  portion,  and  of  accumulation  of  feces  or 
foreign  bodies.  Specific  lesion  might  also  cause  stricture  by  contraction  of 
a  segment. 

The  fact  that  obstructions  often  follow  constipation  or  diarrhoea  shows 
the  importance  of  lesions  producing  a  bad  bowel  condition.  Volvulus  is  es- 
pecially frequent  at  the  sigmoid  and  at  the  caecum,  enteroptosis  being  often 
the  cause,  through  allowing  the  parts  to  prolapse  and  turn.  The  frequency 
of  spinal  lesions  causing  the  weakened  omental  supports  that  allow  of  the 
ptosis  shows  the  importance  of  spinal  lesion  as  a  factor  in  causing  obstruc- 
tions. Spinal  or  rib  lesion  may  be  looked  to  as  the  original  cause  of  a 
large  number  of  the  various  forms  of  obstruction.  It  may  produce  the 
tumor  whose  pressure  obstructs  the  bowel;  the  peritonitis,  following  which 
adhesions  cause  strangulation;  the  ulceration  in  the  bowel  which  gives  place 
to  cicatrization  and  stricture;  or  the  inactive  condition  of  bowel  motion  and 
secretion  that  allows  of  accumulation  of  old  fecal  matters,  foreign  bodies,. 
etc.  A  healthy  bowel,  perfectly  free  from  the  effect  of  lesion  of  any  kind, 
coul.l  only  under  rare  conditions  become  the  seat  of  one  of  the  various 
forms  of  obstruction. 

The  importance  of  lesion  producing  unhealthy  abdominal  or  internal 
conditions  must  be  acknowledged  in  the  etiology  of  most  of  these  cases. 

The  anatomical  relations  of  these  \arious  lesions  have  already  been 
pointed  out  in  the  consideration  of  various  intestinal  diseases. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  IGQ 

The  Prognosis  must  be  guarded.  Very  many  cases  die,  and  surgical 
measures  have  generall)-  been  considered  necessary  after  the  third  day  of 
obstructfon.  Yet  osteopathic  treatment  has  been  successful  in  a  number  of 
cases  after  the  necessity  for  operation  had  been  urged.  Probably,  as  in  the 
case  of  appendicitis,  many  lives  could  be  saved  by  osteopathic  means  be- 
fore surger)'  is  resorted  to. 

In  chronic  cases  the  prognosis  for  recovery  is  very  favorable.  Most 
cases  could  be  prevented  from  coming  to  the  point  of  absolute  obstruction. 
If  they  could  be  foreseen,  most  acute  cases  could  no  doubt  be  prevented  by 
osteopathic  treatment. 

Treatment:  In  such  cases  as  seem  to  depend  upon  a  special  lesion  it 
should  be  removed.  Generally  the  first  consideration  is  the  alleviation  of 
the  patient's  condition.  Strong  inhibition  of  the  splanchnic  area,  especially 
from  the  gth  to  I2th  dorsal,  and  of  the  lumbar  region,  aids  in  lessening  the 
pain.  This  step  ma)-  be  necessary  before  abdominal  manipulation  can  be 
borne.  This  solar  plexus  should  now  be  inhibited.  A  slow,  deep,  but 
gentle  inhibitive  treatment  should  next  be  given  over  the  bowel  to  relax  the 
tissues,  decrease  the  inflammation,  and  lessen  the  pain.  This  treatment 
may  be  used  also  to  quiet  abnormal  peristalsis  if  present.  After  this  pre- 
liminary treatment  the  practitioner  may  proceed  b\'  careful  palpation  to  lo- 
cate the  seat  of  the  obstruction  if  possible.  This  is  often  impossible,  and 
in  such  cases  one  must  work  over  the  bowel  generally.  In  some  cases  the 
obstruction  is  felt,  or  the  seat  of  the  pain  is  an  indication  of  its  position. 

The  main  work  must  be  done  by  abdominal  manipulation.  The  parts 
of  the  intestine  must  be  so  managed  as  to  be  raised,  straightened,  and 
drawn  away  from  each  other.  The  caecum  and  sigmoid  may  be  raised  and 
straightened,  (Chap  VIII,  divs.  II,  III,  IV.)  Deep  treatment  may  be  made 
in  the  right  and  left  hypochondriac  regions  to  free  the  hepatic  and  splenic 
plexuses.  In  intussusception  the  parts  should  be  raised  and  drawn  from 
each  other  toward  the  extremities  of  the  c)'lindrical  tumor,  if  it  can  be  made 
out.  In  volvulus,  raising  and  straightening  the  involved  portions  is  relied 
upon. 

The  stricture  and  adhesions  may  be  manipulated  with  the  purpose  of 
softening,  relaxing,  and  breaking  them  down.  Foreign  bodies  and  fecal 
aggregations  must  be  gradually  loosened  and  worked  along  the  bowel. 
They  are  more  readily  handled  than  other  forms.  It  may  be  necessary  to 
manipulate  them  after  rectal  injection,  to  aid  in  moving  them.  Copious 
injections  sometimes  aid  in  overcoming  intussusception,  voK'ulus,  etc. 
During  the  abdominal  treatment  it  is  well  for  the  patient  to  be  placed  in 
various  positions;  upon  the  back,  sides,  upon  the  abomen,  etc.,  to  get  the 
aid  of  gravity  in  righting  the  parts.  Some  writers  recommend  thorough 
shaking  of  the  patient.  He  is  held  by  four  men  by  the  arms  and  legs,  first 
with  the  abdomen  upward,  then  downward,  while  the  shaking  is  done. 

There  should  be  much  persistence  in  the  treatment.     The    practitioner 


no  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

should  remain  continuously  with  the  case,  and  treat  it  as  much  as  practi- 
cable, until  relieved.  In  the  intervals,  hot  applications  over  the  seat  of 
the  pain  may  made. 

In  chronic  cases  the  treatment  may  be  carried  on  as  usual,  upon  the  plan 
given  above  for  the  treatment  of  acute  cases.  After  removal  of  obstruction, 
a  thorough  course  of  general  treatment  should  be  undertaken  for  the  re- 
moval of  lesions  that  have  originally  impaired  the  bowel  or  have  produced 
abnormal  abdominal  conditions. 


ENTEROPTOSIS. 

Enteroptosis  is  a  disease  in  which  various  of  the  abdominal  and  pelvic 
viscera  leave  there  natural  positions,  slipping  downward  into  the  abdominal 
and  pelvic  cavities.  It  is  a  common  and  distressing  complaint,  frequently 
overlooked  or  not  recognized.  It  is  sometimes  regarded  as  a  symptom 
group,  but  ma\',  from  the  osteopathic  point  of  \ie\v,  be  regarded  as  an 
idiopathic  condition,  due  to  specific  lesion. 

These  cases  are  often  treated  for  some  one  feature,  as  for  nervous  d)s- 
pepsia,  constipation,  operation  for  floating  kidne)',  etc.  It  is  a  common 
error  to  overlook  the  essential  condition  of  the  disease.  The  Osteopath 
who  gives  close  attention  to  a  class  of  neurasthenic,  flat-chested,  consti- 
pated patients,  who  complain  of  lack  of  bodily  and  mental  vigor,  many  and 
various  indefinite  nervous  symptoms,  abdominal  pulsation,  vaso-motor  dis- 
turbance, etc.,  will  find  most  interesting  material.  The  multitude  of  symp- 
toms may  vary  greatl)'  in  different  cases,  but  the  presence  of  neurasthenic 
conditions,  altered  thorax  and  spine,  and  unnatural  abdominal  condition, 
either  of  walls,  viscera,  or  both,  will  usually  afford  an  unmistakable  sign  of 
the  disease.  After  a  little  experience  with  such  cases  one  learns  to  recog- 
nize them  at  a  glance  when  presented  for  examination.  Once  seen  these 
cases  can  hardl)*  be  mistaken,  and  a  few  moments  examination  reveals  a 
story  of  disease  beginning  imperceptibh',  the  growing  conviction  through 
many  months  or  some  years  that  something  was  the  matter,  the  attempt  to 
seem  well  because  no  decided  disease  seemed  present,  or  a  long  course  of 
treatment  for  various  ills,  none  of  which  reached  the  true  condition.  This 
most  common  disease  is  still  but  seldom  clearly  recognized  or  intelligently 
handled. 

Lesions  and  Causes:  The  common  description  of  its  aetiology  is  un- 
satisfactorw  Tight  lacing,  traumatism,  muscular  strain,  and  repeated  peg- 
nancies  are  mentioned.  The  condition  of  relaxed  abdominal  walls  and 
prominent  viscera  due  to  repeated  pegnancies  ma)-  probably  be  rightly 
regarded  as  a  separate  condition.  It  is  due  to  a  ph)siological  act,  and  does 
not  present  those  specific  lesions  nor  the  resulting  symptoms  found  in  neu- 
rasthenic enteroptosis.     Tight  lacing,  traumatism,  and  muscular  stran    may 


PRACTICE  AXD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  Ill 

produce  those  lesions  found  to  be  the  causes  of  such  conditions. 

These  cases  commonly  present  spinal,  rib,  diaphragmmatic  and  abdom- 
inal lesions.  Spinal  lesions  may  be  of  any  of  the  kinds  found  the  spine 
ordinarily,  and  may  occur  anywhere  along  the  splanchnic  or  lumbar  region. 
Rib  lesions  may  occur  in  any  or  all  of  the  lower  six  ribs  on  either  side.  " 

Mobility  of  the  tenth  rib  is  regarded  by  a  German  physician.  Dr.  B. 
Stiller,  (Phila.  Med.  Journal,  Jan.  13.  1900,)  as  the  pathognomonic  cause  of 
enteroptosis.*  Undoubtedly  it  could  interfere  with  the  sympathetic  con- 
nections of  the  abdominal  viscera  and  become  a  factor  in  causing  this  con- 
dition. But,  from  an  osteopathic  view-point,  lesions  of  other  ribs,  and  of 
spinal  vertebrae,  etc.,  may  be  as  potent  in  producing  the  "basal  neuropathy" 
concerned  in  this  disease  as  its  fundamental  pathological  condition.  Further, 
rib  lesions  may  cause  a  condition  of  the  diaphragm  in  which  its  normal 
tone  is  lost,  and  prolapse  in  it  causes  ptosis  in  the  abdominal  organs  which 
it  aids  in  supporting,  (p.  loo.)  Spinal  lesions  may  participate  in  causing 
the  atonic  condition  of  the  diaphragm. 

Spinal  and  rib  lesion,  aside  from  derangement  of  the  diaphragm,  acts  to 
produce  enteroptosis  by  interfering  with  the  spinal  sympathetic  connections 
of  the  viscera  and  of  their  omental  supports.  Impeded  circulation  and 
nerve-supply,  vaso-motor,  motor,  secretory,  trophic  and  sensor\-,  produces 
at  the  same  time  derangement  of  function  in  the  organs  and  weakness  in 
their  mesenteric  supports.  These  conditions  work  together  to  bring  about 
the  disordered  function  and  the  displacement  of  these  organs.  The  dis- 
placement of  itself  furthers  the  present  bad  conditions  by  mechanically  in- 
terfering with  the  activities  of  organs,  stretching  nerve-fibres  and  blood-ves- 
sels which  are  carried  in  the  now  elongated  omenta,  kinking  the  colon  at 
various  points,  etc.  The  viscera,  having  sunk  down  into  the  abdominal 
cavity,  cause  prominence  of  the  lower  abdomen,  leaving  a  hollow  in  the 
ui)per  abdomen,  thus  giving  to  it  the  peculiar  boat-shaped  appearance 
described  as  "scaphoid  abdomen." 

Lower  dorsal  and  lumbar  lesion  may  interfere  with  the  spinal  innerva- 
tion of  the  abdominal  walls,  cause  them  to  loose  their  tone  and  to  dilate. 
Intra-abdominal  pressure  is  thus  lessened  and  the  organs  are  allowed  to 
prolapse. 

According  to  Byron  Robinson,  enteroptosis  begins  with  a  weakening 
of  the  abdominal  sympathetic,  which  looses  its  normal  power  over  circula- 
tion, secretion,  assimilation  and  rhythm.  That  this  weakness  of  the  abdom- 
inal sympathetic  and  its  consequent  loss  of  function  originates  in  spinal 
lesion  to  its  origin  in  the  splanchnic  nerves  has  already  been  pointed  out 
and  fully  discussed  in  considering  the  diseases  of  the  stomach  and  intes- 
tines q.  v.  T\\^  anatomical  relations  oi  such  le>ions  to  parts  affected  was 
pointed  out. 

The  Prognosis  in  these  cases  is  very  favorable,  but  the  progress  of  the 


Boston  Osteopath,  Jan.  14, 19'J0. 


112  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

cure  is  likely  to  be  slow,  Generall\-  improvement  begins  immediatel)'  upon 
treatment  and  maj' progress  to  a  cure  in  a  few  months.  Other  cases  yield 
more  slowly,  though  relief  if  soon  given,  and  require  an  extended  course  of 
treatment  to  effect  a  cure. 

The  Treatment  must  be  both  constitutional  and  local.  The  latter  con- 
sists in  the  removal  of  lesion  and  in  abdominal  treatment.  Lesions  any- 
where to  the  splanchnic  and  lumbar  regins,  to  the  ribs,  thorax  and  dia- 
phragm, must  be  treated  after  their  kind,  according  to  directions  given  in 
Part  I.  With  spine,  ribs,  and  diaphragm  restored  to  normal  conditions,  the 
underlying  causes  of  the  enteroptosis  have  been  removed.  Corrected  nerve 
and  blood-suppl)-  to  the  organs  and  their  supports,  aids  in  correcting  their 
function  and  strengthens  the  supporting  tissues  to  hold  them  in  place  when 
restored  by  abdominal  manipulations. 

Correction  of  spinal  lesion  also  aids  in  restoring  nutrition  and  tone  to 
the  relaxed  and  atrophied  abdominal  walls.  This  process  is  furthered  by  a 
thorough  treatment  upon  the  abdominal  walls.  This  renders  the  use  of  the 
favorite  abdominal  bandage  unnecessary,  and  it  is  gradually  laid  aside. 
Throughout  the  course  of  the  case  the  restored  abdominal  walls  act  as  the 
mechanical  bandage  has  done  to  hold  the  organs  to  their  places  as  replaced 
by  the  treatment.  With  corrected  spine,  free  blood  and  nerve-suppl}'  to 
all  the  \isceral  supports,  and  a  strengthened  abdominal  wall,  no  difficulty 
is  found  in  getting  the  parts  to  gradually  be  retained  in  their  normal  posi- 
tions. Thorough  spinal  stimulation  over  the  splanchnic  and  lumbar  areas 
is  kept  up  for  the  purpose  of  increasing  the  blood  and  nerve-suppl)'  to  the 
parts  in  question. 

Abdominal  work,  aside  from  treatment  of  the  walls,  is  directed  to  rais- 
ing and  replacing  the  viscera.  This  is  readily  accomplished  by  various 
treatments.  (II,  III.  IV,  Chap.  VIII).  This  releases  and  renews  circula- 
tion and  nerve-supply  at  the  same  time,  removes  pressure  of  organs  upon 
each  other,  gives  freedom  of  motion,  and  aids  in  strengthening  the  omenta 
to  hold  the  parts  in  place. 

The  diaphragm  has  been  restored  to  normal  position  and  tone  b\-  cor- 
rection of  those  lesions  originally  deranging  it. 

The  constitutional  treatment  must  be  thorough  and  general  to  restore 
the  patient  from  the  nervous,  circulatory,  nutritional,  and  other  effects  of 
the  disease.  A  most  thorough  general  spinal  treatment  must  be  given. 
Thorough  stimulation  or  heart  and  lungs,  treatment  of  the  cervical  sympa- 
thetic, and  attention  to  kidneys,  liver  and  skin  accomplishes  the  desired 
object.  The  auto-intoxication  usually  present  is  overcome  by  this  treat- 
ment of  the  excretory  organs.  The  constipation,  dyspepsia,  and  other 
functional  disorder  is  corrected  by  the  restoration  of  the  organs  concerned. 

The  patient  should  be  much  out  of  doors,  free  from  worry,  and  care- 
ful not  to  become  fatigued.     Deep  breathing  exercises  are  beneficial. 


^ 


PRACTICE  AXD  APPLIED  THERAPEUTICS  OF  OSTEOPATHV".  II3 


NEUROSES  OF  THE  INTESTINE. 

The  various  lesions  producing  derangement  of  the  intestinal  innerva- 
tion, sensory,  circulatory,  motor,  secretory  and  trophic,  have  been  describ- 
ed. Their  anatomical  relations  to  intestinal  diseases  have  been  fully  dis- 
cussed. Various  of  these  lesions  may  occur  and  produce  intestinal  derange- 
ments by  special  interference  with  certain  functional  activities  of  the  in- 
testines, through  acting  as  lesions  to  the  particular  portion  of  the  innervation 
having  those  functions  in  charge.  Thus  the  lesion  may  so  act  upon  the 
sensory  innervation  as  to  cause  sensory  disease.  Or  the  predominating 
disorder  ma}'  affect  particularly  the  secretory  or  the  motor  functions.  Sen- 
sory, secretor}',  and  motor  neuroses  of  the  intestine  are  common.  The 
lesions  producing  them  are  not  different  in  nature  from  the  ordinary  lesions  ' 
found  as  the  causes  of  gastro-intestinal  disorders.  For  some  reason,  not 
well  understood,  certain  of  these  lesions  may  produce,  in  a  given  case,  cer- 
tain special  kinds  of  disturbance  of  function.  In  the  diseases  described  be- 
low no  special  lesion  has  been  as  }'et  described  as  the  special  cause  of  each 
condition.  One  finds  lesions  already  described  producing  them.  As  a  rule, 
howe\er,  these  special  sensory,  secretory,  or  motor  neuroses  are  noted  in 
cases  of  bad  intestinal  health,  and  frequently  seem  to  be  specialized  patho- 
logical manifestations  of  this  general  bad  condition.  The  sensory,  secre- 
tory, or  motor  disturbance  has  gained  the  upper  hand.  In  some  cases  the 
"■neuroses  is  itself  the  sole  manifestation  of  the  results  of  the  lesion. 

J 


SECRETORY   NEUROSES. 

Membraneoics  Enteritis,  or  Mucous  Colitis,  is  often  met,  frequently  occur- 
ing  in  subjects  of  intestinal  disease.  The  special  lesions  present  and  dis- 
turbing bowel  innervation  act  particularl\-  upon  the  secretory  fibres.  The 
result  is  over-action  in  the  mucous  secreting  glands.  The  mucous  mem- 
brane is  not  pathologically  altered,  and  catarrh  if  present  at  all,  is  a  second- 
ary effect.  It  is  a  purely  nervous  manifestation.  Special  lesion  is  com- 
monly found  to  be  the  active  cause  of  irritation  to  the  centers  or  fibres  con- 
trolling this  funcnion.  Its  results  are  apparent  in  the  copious  secretion  of 
intestinal  mucous,  which  passes  away  from  the  patient  in  conglomerate 
masses  forming  the  whole  or  a  separate  part  of  the  stool,  in  long  ribbon- 
like strips,  or  in  a  complete  cast  of  the  intestinal  canal  of  some  inches  in 
length. 

It  is  not  a  serious  condition,  and  removal  of  lesion,  with  thorough 
spinal  and  abdominal  treatment,  will  at  once  begin  to  correct  the  over-act- 
ion of  the  glands.  Its  cure  may  depend  upon  the  restoration  of  a  general 
healthy  bowel  condition.  Relief  is  generally  obtained  at  once  from  the 
treatment,  but  considerable  treatment  may  be  necessa.iy  to  eradicate  the 
chronic  condition.     Tenesmus,  when  present,  is  relieved    by   strong    sacral 


I  14  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

Stimulation,     Colic  is  relieved  b\'  stion<T  spinal  inhibition  and  by    local    in- 
hibitive  treatment  at  the  seat  of  the  pain  in  the  abdomen. 

SENSORY  NEUROSES. 

These  disturbances  are  due  to  irritation  to  the  sensory  nerves  supplied 
by  the  splanchnics  to  the  intestines. 

Enteralgia,  Colic,  ox  Intestinal  Neuralgia,  is  met  with  in  neurotic  and 
anemic  subjects,  and  attacks  are  induced  by  exposure,  gout,  and  local  irri- 
tation to  the  sensory  nerves  of  the  intestine  by  inflamation,  enteroliths,  etc. 
Excepting  mechanical  irritants,  lead  poisoning,  and  like  agencies,  the  actu- 
al cause  that  weakens  the  intestines  and  lays  them  liable  to  the  action  of 
such  exciting  causes,  is  spinal  lesion  irritating  or  weaking  the  sensor)'  cen- 
ters or  fibres.  Many  cases  occur  spontaneousl)-  from  spinal  lesion.  This 
spinal  lesion  may  act  b\"  causing  increased  activity  in  the  muscularis,  lead- 
ing to  the  ring-like  contractions  of  the  intestine  present  in  colic.  In  many 
of  these  cases  intestinal  cramps  cause  localized  contractions  in  portions  of 
the  intestines,  which  may  be  readily  seen  or  felt  through  the  intestinal 
walls.  Here  the  most  ef^cient  treatment  is  b}-  local  manipulation  over  the 
seat  of  the  contraction.  Deep  inhibitive  treatment  here  quiets  the  nerves 
and  releases  the  spasm.  Such  local  work  must  be  supplemented  by  cor- 
rective work  upon  the  spine,  which  prevents  further  attacks.  Strong  spinal 
inhibition  may  be  used  to  quiet  the  pain.  Some  one  point  is  generally 
found  along  the  splanchnic  area  at  which  inhibition  is  effective.  This  is 
often  high  up  in  the  splanchnic  region,  but  \'aries  with  the  case,  and  is 
found  by  trial.  Special  lesion  is  to  be  removed,  and  stoppage  of  the  pain 
may  depend  upon  that. 

Dimiyiished  Sensibility  of  the  intestines  is  a  common  neuroses.  It  may 
be  both  sensor}-  and  motor,  and  leads  to  diminished  peristalis,  constipation 
and  accumulation  of  the  feces  in  a  portion  of  the  intestine,  often  in  the 
rectum.  It  is  likely  to  occur  in  diseases  of  the  brain  and  cord  in  which  the 
centers  are  effected.  Special  spinal  lesion  is  often  the  direct  cause,  or 
causes  the  cord  disease.  Cure  of  this  condition  in  such  cases  depends  up- 
on cure  of  the  primary  disease.  In  other  cases,  removal  of  lesion,  and  res- 
toration of  activity  to  the  local  nerve  mechanism  overcomes  the  paresis. 
Spinal  and  abdominal  treatment,  directed  especiall)'  to  the  course  of  the  in- 
testine, to  affect  Auerbach's  plexus,  and  to  the  solar  plexus,  will  aid  a  cure. 
Specific  lesion  may  cause  a  paretic  condition  of  a  bowel  segment  and  be  re- 
sponsible for  the  trouble.  A  general  weak  condition  of  the  nervous  sys- 
tem, on  account  of  which  nervous  shocks  and  other  disturbances  cause  this 
condition,  must  be  remedied  by  upbuilding  it. 

MOTOR  NEUROSES. 

Ne}~'ous  Diarrhoea  is  a  condition  in  which  increased  contractility  of 
the  muscularis  of  the  bowel  is  aroused  by  purely  nervous  causes.  It  is  an 
overaction  of  the  bowel,  not  presenting  the  usual  aspects  of  diarrhoea.   The 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  1 1  5 

Stools  are  softer  than  normal,  and  frequent,  occuring  two,  three,  four,  or 
more  times  in  twenty-four  hours.  The  subject  is  as  a  rule  a  neurotic,  be- 
ing hysterical,  neurasthenic,  or  of  a  very  nervous  temperament,  but  the 
characteristic  lesions  found  in  diarrhoea,  q.  v.,  are  present  and  so  act  upon 
the  nerve-mechanism  of  the  bowel  as  to  lessen  its  motor  stability.  Thus 
its  abnormal  activity  made  possible  by  the  lesion  becomes  the  special  mani- 
festation of  the  nervous  condition.  There  must  be  some  sufficient  reason 
why  the  general  nervous  condition  should  be  able  to  so  center  itself  upon 
the  bowel.  The  presence  of  such  lesions  as  anat^ically  weaken  the  bowel 
affords  a  reasonable  explanation  of  this  phenomenon.  These  lesions,  usu- 
ally of  the  lower  dorsal  and  lumbar  regions,  probably  affect,  through  its 
connections  with  the  nth  and  12th  dorsal  and  the  1st  and  2nd  lumbar 
nerves,  the  inferior  mesenteric  ganglion  ruling  motor  activity  in  the  fecal 
reservoir. 

The  treatment  commonly  enplo}'ed  for  diarrhoea  is  efficient  in  checking 
this  form.  At  the  same  time,  thorough  general  spinal  and  neck  treatment 
must  be  gi\en  to  strengthen  the  nervous  system.  Spinal  causes  of  the  ner- 
vous condition  must  be  sought  and  overcome.  The  case  yields  rapidly  to 
treatment,  but  is  ver)'  prone  to  setbacks  due  to  nervous  disturbance.  For 
this  reason  the  patient  must  be  kept  as  free  from  exciting  influences  as 
possible.  The  condition  is  apt  to  recur  until  the  nervousness  has  been 
lessened.     Fortunately  this  latter  condition  yields  readily  to  treatment. 

Enteropasm  is  a  neurosis  of  the  intestine  in  which  a  spasmodic  condi- 
tion of  portions  of  the  intestinal  walls  occurs.  It  may  result  in  temporary 
obstruction,  but  its  most  usual  manifestation  is  to  cause  the  stools  to  be 
passed  in  separate,  rounded  masses,  or  in  ribbon-shape.  The  latter  is  most 
frequent.  While  often  a  nervous  phenomenon,  special  lesion  is  necessary 
to  account  for  this  peculiar  manifestation  of  nervousness.  Special  lesion 
may  affect  the  inferior  mesenteric  ganglion  through  its  spinal  connections^ 
or  the  motor  fibres  of  the  circular  muscles  of  the  rectum,  originating 
from  the  lower  dorsal  and  upper  one  or  two  lumbar  nerves,  and  passing 
thence  through  the  inferior  mesenteric  ganglion  to  the  rectum. 


CHOLERA  MORBUS. 

Definition:  Cholera  morbus  is  an  acute  catarrhal  inflammation  of  the 
stomach  and  intestines,  characterized  by  severe  abdominal  pain,  colic,  vom- 
iting, purging,  and  muscular  cramps. 

Cases:  (i)  A  young  man  in  intense  pain;  had  vomited  blood  several 
times,  and  continuous  severe  vomiting  and  purging  were  present,  had  a 
chill;  severe  griping  in  the  epigastric  and  umbilical  regions.  Inhibition  at 
the  4th  and  5th  dorsal  vertebrae,  on  the  right,  stopped  the  vomiting.  Inhi- 
tion  of  the  splanchnics  stopped  the  purging.     Cracked  ice  was  allowed  the 


Il6  PRACTICE  AND  APPLIKD  THERAPEUTICS  OF  OSTEOPATHY. 

patient,  and  a  hot  enema  was  administered  After  the  first  treatment  no 
vomiting  or  purging  occured,  and  rapid  recovery  followed.  In  his  prexioiis 
attacks  he  had  usually  remained  in  bed  for  three  days,  being  incapacitated 
for  a  week.     Morphine  was  usually  necessary  to  stop  the  pain. 

(2)  Severe  nausea,  vomiting  and  cramps  disappeared  at  once  under  the 
treatment. 

Lesions:  Such  lesions  as  described  for  enteritis,  q.  v.,  are  present  in 
these  cases,  weakening  tiie  bowel  and  rendering  it  susceptible  to  the  agen- 
cies usually  described  as  the  exciting  causes.  The  irritation  of  bad  food, 
etc.,  may  affect  a  healthy  bowel  in  this  manner,  but  there  is  often  no  such 
factor  in  the  case.  Simple  chilling  of  the  bod)'  may  cause  the  attack,  or 
slight  indiscretion  in  diet  may  bring  it  on. 

The  Prognosis  is  good.  Treatment  relieves  the  case  at  once,  stopping 
the  pain,  vomiting,  cramps,  etc.     The  patient  rapidly  recovers. 

Treatment:  Correction  of  lesion  protects  the  patient  against  further 
attacks.  The  severe  abdominal  pain  and  colic  are  removed  by  strong  inhi- 
bition of  the  spine,  especially  over  the  splanchnic  area,  and  from  the  9th  to 
the  I2th  dorsal.  This  quiets  the  sensory  nerves  of  the  viscera.  Deep  inhib- 
itive  treatment  upon  the  abdomen,  over  the  seat  of  the  pain  and  about  it, 
aids  in  relieving  it.  The  vomiting  is  checked  as  before  described,  (p.  84), 
as  is  the  diarrhoea.  The  cramps  in  the  calves  are  relieved  by  strong  in- 
hibition over  the  sacrum  and  upon  the  popliteal  nerve  in  the  popliteal 
space.  The  system  should  be  strengthened  against  collapse  b)'  stimulation 
of  heart  and  lungs  and  by  spinal  and  neck  treatment  for  the  general  system. 


HEMORRHOIDS. 

Definition:  Varicose  enlargements  of  the  inferior  hemorrhoidal  veins 
or  of  the  hemorrhoidal  plexus. 

Cases:  (i)  Protruding  piles  of  fourteen  years'  standing  cured  in  two 
months. 

(2)  Hemorrhoids  of  four  years'    duration    cured    in    four  treatments. 

(3)  Protruding  piles  of  many  years'  standing,  accompanied  by  consti- 
pation, cured  in  two  months. 

(4)  Hemorrhoids  and  constipation.  Lesion  at  5th  lumbar,  coccyx  badly 
bent.  (5)  7th  to  nth  dorsal  vertebrae  posterior,  coccyx  anterior,  innomi- 
nate forward.  Hemorrhoids  were  accompanied  by  indigestion  and  jaun- 
dice. (6)  Internal  hemorrhoids  and  constipation,  no  natural  bowel  mo- 
tion for  several  years;  cured  in  one  month.  (7)  Protruding  piles  of  several 
years' standing,  constipation,  prolapsed  rectal  walls.  Lesion  caused  by 
strain  from  heav}-  lifting.  A  weakened  lumbar  region.    Cured  in  one  month. 

(8)  Constipation  and  piles  of  many  )'ears'  standing  caused  by  a  bent 
coccyx.     Four  treatments  gave  great  relief;  case  still  under  treatment. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  II7 

Lesions  AND  Causes:  The  common  bony  lesion  jjresent  is  a  bent  or 
dislocated  coccyx,  which  acts  as  a  local  irritant  and  mechanical  impediment 
of  the  venous  return  from  the  hemorrhoidal  veins.  Luxated  coccyx,  by  lo- 
cal irritation  and  interference  with  the  fourth  sacral  nerve,  may  cause  ob- 
stinate contracture  of  the  external  sphincter,  leading  to  constipation  or 
straining  at  stool.  Possibly  coccygeal  and  innominate  or  sacral  lesion,  by 
direct  interference  or  by  dragging  of  tissues,  derange  the  sacral  nerves  sup- 
plying motor  fibers  to  the  longitudinal  muscle  fibers  of  the  rectal  walls, 
weakening  them.  This  result  would  probably  be  aided  by  the  interference 
of  these  same  lesions  with  the  sympathetic  (sacral)  nerve-suppl}' to  the  cir- 
culation through  branches  contributed  to  the  lower  hypogastric  and  hem- 
orrhoidal plexuses.  That  of  the  coccyx  seems  to  be  the  most  important 
lesion  in  hemorrhoids. 

Lumbar  and  lower  dorsal  lesion  may  be  present  and  interfering  with 
the  innervation  of  the  abdominal  walls,  relaxing  them,  lessening  intra-ab- 
dominal pressure,  and  allowing  of  congestion  of  the  abdominal  circulation. 
B)'  direct  effect  or  b)'  causing  constipation,  this  condition  may  cause  hem- 
orrhoids. Lower  dorsal  and  upper  lumbar  lesion  to  the  nerve  fibers  which 
pass  by  way  of  the  inferior  mesenteric  ganglion  to  suppl)'  motor  fibers  to 
the  circular  muscles  of  the  rectal  walls  may  become  a  factor  b)'  weakening 
the  wall,  relaxing  its  tone,  and  -allowing  of  a  congestion  in  its  vessels. 
Lesion  to  the  splanchnic  and  lumbar  areas,  affecting  the  sympathetic  sup- 
ply which,  through  the  splanchnics,  solar  plexus,  and  other  sympathetic 
vaso  and  viscero-motors  originating  along  these  areas,  rules  circulation  and 
muscular  tonus  in  the  abdominal  and  pelvic  viscera,  may  contribute  in  an 
important  way  to  causation  of  hemorrhoids.  Likewise  those  lesions  to  the 
spine  and  lower  ribs,  well  known  as  causes  of  liver-derangement,  become 
causes  of  hemorrhoids  by  producing  obstructed  portal  circulation  and  con- 
stipation. The  chief  drainage  of  the  hemorrhoidal  plexus  of  veins  is 
through  the  portal  circulation  by  way  of  the  superior  hemorrhoidal  vein. 
Lesions  causing  disease  of  heart  and  lungs,  q.  v.,  may  secondarily  become 
the  causes  of  hemorrhoids  through  the  impeded  systemic  circulation  re- 
sulting. Lesions  causing  atomic  diaphragm  (p.  100),  and  other  causes  of 
enteroptosis,  q.  v.,  produce  hemorrhoids  b}-  the  mechanical  obstruction  of 
circulation,  and  by  deranged  nerve  suppl>',  etc. 

The  a?iafojn/cal  re/ah'o)is  are  pointed  out  above.  The  American  Text 
Book  of  Surgery  calls  attention  to  the  fact  that  these  veins  are  unsupplied 
with  valves  and  also  that  they  tend  to  become  congested  by  the  natural  up- 
right position  of  the  body.  These  facts  aid  in  explaining  the  potency  of 
the  above  lesions,  and  of  any  obstructive  condition  (pregnancy,  over-eating, 
etc.)  in  causing  this  condition. 

The  EXAMINATION  must  be  made  by  both  inspection  and  palpation,  the 
use  of  a  proper  speculum  aiding  a  thorough  inspect'on  of  the  rectum. 

The  Prognosis  is  very  favorable.     The   usual  medical  treatment  is  pal- 


I  iS  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTKOPATHV. 

liativc,  or  surgery  is  resorted  to.     The  latter  may  often   become    necessary, 
but    the    success    of    osteopathic    treatment     prevents     many    operations. 

Even  the  most  severe  cases  have  been  successfully  treated.  The  treat- 
ment generally  begins  to  succeed  immediately.  Long  standing  cases  are 
often  cured  in  a  few  months.     Some  cases  are  slow  and  obstinate. 

The  Treatment  is  local,  abdominal,  spina!  and  constitutional. 

Local  treatment  is  first  directed  to  correcting  the  coccyx  if  necessary. 
(XX,  Chap.  II.)  The  external  sphincter  should  be  well  dilated.  This  may 
be  accomplished  by  inserting  two,  or  even  three,  fingers,  well  vaselined,  and 
held  together  at  the  tips  in  wedge-shape.  After  being  well  inserted,  they 
are  spread  apart  and  withdrawn  carefully.  The  dilatation  must  be  thorough. 
The  rectal  speculum  maybe  used  for  this  purpose.  All  the  surrounding 
tissues,  both  externally  and  internally,  are  to  be  thoroughly  but  gently  re- 
laxed. Internally  this  operation  should  be  carried  as  far  up  along  the  rec- 
tal walls  as  the  index  finger  is  able  to  work.  Pressure  is  made  upon  the 
injected  veins  to  empty  them  of  blood  and  to  stimulate  their  local  nerve 
and  muscle  substance  to  proper  tonus.  In  case  of  thrombi  in  strangulated 
\-eins,  the  manipulation  about  and  upon  them  must  be  gently  applied  with 
the  purpose  of  stimulating  the  circulation  to  a  gradual  absorption  of  them. 
They  must  not  be  broken  up  or  detached,  as  there  is  danger  of  their  being 
swept  into  the  circulation  as  emboli. 

After  dilatation  of  the  spliricter  and  relaxation  of  the  tissues,  protrud- 
ing piles,  first  emptied  if  possible,  must  be  gently  pressetl  back  beyond  the 
sphincter.  If  the  rectal  walls  are  prolapsed,  as  is  often  the  case  in  protrud- 
ino'  piles,  they  must  be  replaced  by  the  index  finger  directed  to  straighten- 
ing out  and  pushing  them  up  on  all   sides. 

This  local  work  removes  irritation  of  the  cocc)x,  frees  the  whole 
local  circulation,  tones  the  local  musculature  and  other  tissues,  and  stimu- 
lates the  local  sympathetics.  It  may  be  the  sole  and  suf^cient  treatment 
in  many  bad  cases.     It  should  be  given  but  once  per  week  or  ten   da}s. 

Abdcminal  treatment  is  for  the  purpose  of  increasing  freedom  of  circu- 
lation and  to  aid  in  the  venous  return.  The  solar  and  h\-pogastric  plexuses 
are  stimulated  and  manipulation  is  made  over  the  course  of  the  inferior 
mesenteric  and  common  and  internal  iliac  arteries.  Portal  circulation  is 
helped  by  deep  abdominal  work  from  the  lower  abdominal  region  upward 
to  the  liver.  Lesions  to  the  latter  organ  are  removed,  and  thorough  treat- 
ment given  to  the  liver  as  in  the  treatment  for  constipation,  q.  v., which  must 
be  relieved,  it  being  usually  present.     (V.  Chap.  VIII.) 

The  viscera  are  raised,  and  treatment  is  made  deep  in  the  iliac  fossae  to 
stimulate  the  pelvic  sympathetic  pexuses  and  to  aid  venous  return  from  the 
hemorrhoidal,  vescical,  uterine,  and  other  related  flexuses  of  veins.  (II,  III, 
I\\  Chap.  VIII).  If  the  patient  is  placed  in  the  knee-chest  position  while 
abdominal  treatment  is  performed  with  the  ideas  explained  above,  the  force 
of  CTravitatation  is  made  to  assist  in  venous  drainage  of  the  parts. 


PRACTICE  AND  APPUKD  THERAPEUTICS  OF  OSTEOPATHY.  II9 

Enteroptosis  and  diaphragmmatic  lesion  are  repaired  as  before  ex- 
plained. 

Thorough  spinal  treatment  is  given  from  the  sixth  dorsal  down,  stimu- 
lating splanchnics  and  other  sympathetics,  with  all  their  contained  vasoand 
viscero-motor,  circulatory,  and  trophic  fibres.  This  treatment  is  to  strengthen 
circulation  and  to  maintain  its  freedom.  It  is  supplementary  to  the  abdom- 
inal work.  It  also  aids  in  restoring  tone  to  the  vessel  walls,  as  well  as  to 
prolapsed  rectal  walls,  and  thus  to  maintain  them  in  correct  condition. 
Anatomical  relations  between  the  spinal  work  and  abdominal  and  pelvic 
viscera  have  before  been  fully  explained. 

Correction  of  spinal,  rib,  or  innominate  lesion  is  made  if  necessary.  In 
this  way,  and  by  work  along  the  lower  dorsal  and  upper  lumbar  regions, 
coupled  with  the  local  treatment  upon  the  abdominal  walls,  the  latter  are 
built  up  and  restored  to  normal  tonus  if  relaxed. 

The  r^^/5/'///^//(?;m/ treitment  consists  in    the    general    spinal    treatment 
and    in    special  treatment  for  heart  and  lung  disease  if  present  and  causing 
the  hemorrhoids. 

Light  out-door  exercise  and  absolute  personal  cleanliness  should  be  en- 
joined upon  the  patient. 

INTESTINAL  TUMORS. 

Intestinal  Tumors  of  various  kinds,  both  benign  and  malignant  have 
been  frequently  treated  osteopathically  with  sucsess.  Medical  treatment  is 
but  palliative,  and  the  onl)-  means  of  remo\'al  has  been  b\'  surgical  opera- 
tion. The  fact  that  in  numerous  instances  these  cancers  and  tumors  have 
been  entirely  removed  by  osteopathic  treatment  is  '.n  itself  remarkable,  and 
helps  to  sustain  the  claim  often  made,  that  the  use  of  the  knife  is  often  ob- 
viated in  the  treatment  of  such  conditions. 

The  Treatment  is  simple,  and  consists  in  the  removal  of  spinal  lesion 
which  may  be  of  any  of  the  kinds  discribed  as  producing  gastro-intestinal 
disease.  At  bottom  the  real  cause  of  these  growths  is  some  obstruction  or 
irritation  to  local  blood  and  nerv^-supply.  It  has  alread)'  been  shown  how 
special  lesion  causes  this  obstruction,  or  lays  the  foundation  of  the  condi- 
tion which  directly  or  indirectly  producss  the  irritation.  The  treatment  is 
therefore  the  removaj  of  lesion  and  the  restoration  of  normal  nerve  and 
blood  supply.  Spinal  treatment,  aided  by  abdominal  work  accomplishes 
this  object.  The  latter  is  done,  not  upon  the  tumor  itself,  but  upon  the 
surrounding  parts.  It  relaxes  tensed  tissues,  opens  arterial  blood-suppl)- 
and  venous  and  lymphatic  drainage,  and  restores  normal  condition.  In 
this  way  the  progress  of  the  morbid  process  is  stopped,  healthy  tissue  is 
built,  and  the  tumor  disappears,  probably  by  absorption.  At  least  one  case 
is  upon  record  in  which  the  tumor,  a  fibroid,  was  loosened  by  the  treatment 
and  passed  per  rectum.     (Cosmopolitan  Osteopath,  Feby.,  igoo,  p.  30.) 

Attendant  conditions,  such  as  cotstipation,  fecal  impaction,  colic,  etc., 
are  treateed  as  described  elsewhere. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  121 


PERITONITIS. 

Definition:  An  acute  or  chronic  inflammation  of  the  peritoneum, 
localized  or  general. 

Cases:  (i)  A  case  diagnosed  as  septic  peritonitis,  probably  caused  by- 
appendicitis,  under  the  care  of  celebrated  Chicago  physicians  grew  steadily 
worse  until  death  was  expected  in  a  few  hours.  No  hopes  of  recovery  were 
entertained,  and  it  was  evident  that  the  best  medical  treatment  was  of  no 
avail.  As  a  last  resort  an  Osteopath  was  finally  called,  all  medical  treat- 
ment was  discontinued,  and  the  treatment  began.  Immediatel}',  under  the 
treatment,  the  great  pain  that  had  been  present  for  hours  at  a  time,  was 
controlled,  and  during  the  next  four  weeks  not  two  hours'  pain  in  all  was 
experienced.  The  other  symptoms  were  also  controlled,  and  the  outcome 
was  a  cure.  Spinal  lesions  were  discovered  upon  examination,  and  led  to 
inqiury  concerning  accident,which  brought  out  the  fact  that  the  bo\-  had  had  a 
serious  fall  a  few  weeks  before.  Ihese  were  held  to  be  the  primary  cause 
of  the  peritonitis,  and  treatment  directed  to  them  was  the  cardinal  treat- 
ment. The  fact  that  the  child's  life  was  saved  at  such  a  juncture,  in  dis- 
ease of  such  a  nature,  by  the  removal  of  spinal  lesion,  is  a  convincing  dem- 
onstration of  the  correctness  of  osteopathic  theory  and  practice. 

(2)  A  second  case  presenting  the  ordinary  severe  symptoms  of  the 
disease,  and  in  a  state  of  collapse  when  seen  by  the  Osteopath,  was  cured  in 
five  days  by  the  treatment. 

The  Lesions  expected  in  such  cases  are  to  the  lower  ribs,  the  lower 
dorsal  and  lumbar  spine,  and  sometimes  the  pelvis.  In  such  cases  as  are 
secondary  to  other  disease,  such  as  inflammation  in  the  various  abdominal 
organs,  typhoid  or  diphtheritic  ulcer,  appendicitis,  volvulus,  etc.,  the  active 
lesion  in  the  case  must  be  sought  for  as  the  cause  of  the  primary  disease. 
Such  lesions  may  be  various. 

Anatomical  Relations:  The  nerve-supply  to  the  parietal  peritoneum 
is  from  the  lower  intercostal  and  upper  lumbar  nerves,  which  suppl}'  also 
the  muscles  of  the  abdominal  walls.  The  abdominal  sympathetics  also 
supply  the  peritoneum,  being  chiefly  vaso-motors  for  the  blood-\'essels  in 
the  mesentery,  but  also  having  certain  branches  distributed  directly  to  the 
substance  of  the  peritoneum. 

The  blood-supply  is  from  the  coeliac  axis  through  the  hepatic  and 
splenic  arteries,  and  from  the  blood-supply  of  the  parts  with  which  the  vari- 
ous portions  of  the  mesentery  are  in  relation. 

The  fact  that  the  chief  sympathetic  supply  to  the  peritoneum  is  to  the 
blood-vessels  in  it  is  a  significant  one. 

The  inflammation  of  peritonitis  is  a  vaso-motor  disturbance.  It  has 
been  before  explained  how  spinal  lesion  deranges  spinal  sympathetic  con- 
nections of  the  abdominal  sympathetics  and  produces  disease.     Thus  cer- 


122  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

tain  lesions  among  the  lower  ribs,  and  along  the  lower  spine,  result  in 
derangement  of  the  sympathetic,  which,  when  affecting  the  peritoneum, 
becomes  a  chiefly  vaso-motor  disturbance  because  of  these  peritoneal  sym- 
pathetics  being  mostly  vaso-motors,  and  the  inflammation  results. 

In  another  way,  these  lesions,  affecting  the  lower  intercostal  and  upper 
lumbar  spinal  nerves,  may  become  the  active  cause  of  peritonitis.  Hilton 
shows  that  these  nerves,  supplying  the  skin  and  muscles  of  the  abdominal 
walls,  as  well  as  the  parietal  peritoneum,  probably  also  supply  the  visceral 
peritoneum  and  send  sensory  branches  through  the  sympathetic  to  the 
intestinal  walls.  Quain's  anatomy  shows  that  from  the  9th,  loth,  nth  and 
1 2th  dorsal  nerxes,  sensory  nerves  pass  through  the  sympathetic  to  the 
abdominal  viscera.  It  also  shows  that  from  the  thoracic  sympathetic  and 
from  the  lumbar  s\mpathetic  cord, vaso-motor  fibres  of  the  abdominal  blood- 
vessels take  origin.  The  intimate  relation  between  the  spinal  and  sjmpa- 
thetic  nerves  is  well  known.  Hilton  uses  the  facts  he  points  out  in  regard 
to  this  connected  nerve  mechanism  to  explain  why  the  abdominal  walls  be- 
come painful  and  contracted  from  the  inward  irritation  of  the  inflammation. 
The  connection  of  this  nerve  mecharnsm  for  all  these  related  parts  also  ex- 
plains how  lower  rib,  lower  dorsal,  and  upper  lumbar  spinal  lesions  may  so 
interfere  with  the  vaso-motor  supply  to  the  peritoneal  vessels  as  to  cause 
peritonitis.  This  immense  abdominal  nerve  supply,  both  superficial  and 
internal,  spinal  ind  sympathetic,  offers  the  Osteopath,  both  through  its  sur- 
face distribution,  its  spinal  connections,  and  its  internal  distribution,  a  vast 
and  most  readily  accessible  field  for  his  »work  by  superficial  and  deep 
abdominal  and  spinal  treatment.  This  fact  well  explains  his  good  results, 
even  in  desperate  cases,  in  gaining  control  of  the  \aso-motor  mechanism 
which  is  deranged  in  this  inflammation. 

Through  the  connection  of  this  local  vaso-motor  mechanism  with  the 
vaso-motor  system  of  the  whole  body,  reflex  irritation  is  set  up  which  leads 
to  a  general  vaso-constriction  of  the  \essels  of  the  whole  body  surface. 
Robison  thus  explains  why  the  whole  skin  is  waxy,  pale  and  cold,  saying 
that  thri  patient,  on  this  account,  dies  from  circumference  to  center. 

Robinson  also  shows  that  traumatic  action  of  the  left  end  of  the  dia- 
phragmmatic  muscle  upon  the  gut  wall,  of  the  psoas  niagnus  upon  the  sig- 
moid, and  abrasion  of  the  bowel  mucosa  at  the  splenic  and  sigmoid  flex- 
ures, very  frequently  become  the  causes  of  peritonitis  by  allowing  the  mi- 
gration and  foot-hold  of  pathogenic  bacteria.  Spinal,  or  other  specific 
osteopathic  lesion,  b)'  causing  bad  bowel  conditions  which  allow  of  the  pos- 
sibilit}-  of  such  traumatism  may  be  present,  and  must  be  removed  in  the 
treatment  for,  or  the  prophylaxis  of,  this  disease. 

The  Prognosis  in  these  cases  is  fair.  Considering  that  peritonitis  pa- 
tients usuall}'  die  under  medical  treatment,  in  the  acute  form  of  the  disease, 
and  that  operation  must  frequently  be  resorted  to,  the  success  Osteopathy 
has  had  with  serious  cases  is  marked. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I23 

The  Treatment  must  aim  at  gaining  vaso-motor  control  and  thus  re- 
ducing the  inflammation.  Lesion  must  be  corrected  as  soon  as  possible. 
The  treatment  must  be  both  spinal  and  abdominal.  The  first  step  should 
be  thorough  but  careful  relaxation  of  all  spinal  tissues.  If  the  patient  can- 
not be  turned  upon  his  side,  he  may  continue  to  lie  upon  his  back,  and  the 
operating  hand  may  be  slipped  under  him  to  work  along  the  spine.  Inhibi- 
tion should  be  made  along  the  splanchnic  and  upper  lumbar  regions,  espec- 
ially from  the  gth  to  12th  dorsal,  to  quiet  the  pain  through  inhibition  of  the 
sensory  fibres.  After  spinal  relaxation  and  inhibition,  the  abdominal  treat- 
ment will  be  better  borne.  Through  this  spinal  treatment  effect  upon  vaso- 
motor activities  is  gained  by  way  of  the  sympathetic  connections  explained 
above.  This  aids  in  freeing  the  circulation.  During  the  progress  of  the 
treatment  of  the  case  the  inhibitive  spinal  treatment  may  be  alternated  with 
a  thorough  stimulation  of  the  sympathetic  connections  of  the  parts  involved, 
to  check  peristalsis.  As  soon  as  possible,  thorough  general  spinal  and  neck 
treatment  should  be  given  to  equalize  the  general  circulation,  and  to  over- 
come the  intense  vaso-constriction  of  all  the  superficial  vessels,  so  notice- 
able a  feature  of  the  case.  Heart  and  lungs  should  be  stimulated,  and  in- 
hibition of  the  superior  cervical  region  be  made. 

•  After  spinal  inhibition  very  light  abdominal  treatment  is  given.  The 
walls  are  tense  and  painful,  and  much  care  is  required  in  treating  them. 
The  treatment  should  be  gentle,  relaxing,  and  inhibitive,  thus  relaxing  the 
contractured  muscles,  aiding  general  circulation,  and  decreasing  pain.  On 
account  of  the  relation  between  the  nerves  of  the  abdominal  walls  and  those 
of  the  inward  parts  involved,  as  pointed  out  above,  work  upon  the  abdomi- 
nal walls  has  an  important  corrective  effect  upon  the  morbid  conditions 
present  internally.  The  theory  that  work  upon  nerve  terminals  affects 
parts  supplied  by  connected  nerves  is  well  supported  by  fact.  Thus  restor- 
ation of  a  relaxed  and  natural  condition  of  the  abdominal  walls  it  an  im- 
portant aid  in  restoring  natural  conditions  in  the  parts  supplied  by  these 
connected  nerves.  Gradually,  deeper  work  may  be  done,  affecting  the 
abdominal  sympathetic  locally,  increasing  circulation  and  stimulating 
absorption  of  the  inflammatory  effusions  and  other  products.  Care  must 
be  taken  in  the  treatment  o\'er  the  intestines,  as  their'  walls  are  intensely 
gorged  with  blood,  and  arc  friable. 

The  obstinate  constipation  present  is  due  to  pressure  from  congestion 
of  the  bowel  walls,  and  by  edema  into  them,  checking  peristalsis.  As  the 
circulation  is  restored  this  condition  is  corrected,  and  bowel  action  can  be 
stimulated  by  the  usual  means.  The  liver,  kidneys,  and  skin  should  lie 
stimulated  to  aid  in  carrying  off  the  effusions  and  the  effete  products  of  the 
disease.  The  hiccough  is  relieved  by  inhibition  of  the  phrenic  nerve  (VIII, 
Chap.  III).  Treatment  for  the  fever  (p.  66),  and  for  the  vomiting  and 
tympanites  (p.  84)  is  applied  as  before  directed.  The  treatment  prevents 
the  formation  of  adhesions,  and  takes  down  the  thickening  of   the    periton- 


124  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

eum.  The  patient  should  be  kept  quiet  in  bed,  no  food  should  be  allowed 
as  long  the  vomiting  occurs.  Later  a  restricted  liquid  diet  is  used  in  small 
amounts  at  a  lime.  Cracked  ice  may  be  used  to  allay  the  thirst.  Rectal 
injections  may  be  necessary  to  relieve  the  constipation  at  first. 

The  treatment  of  the  chronic  case  is  directed  to  the  gradual  breaking 
down  of  adhesions;  the  restoration  of  circulation  to  absorb  pus  or  effusion^ 
and  to  remove  the  chronic  inflammation,  and  to  the  relaxation  of  the 
abdominal  tissues.    Correction  of  the  spinal  lesion  must  not    be  neglected. 

Cases  of  acute  peritonitis  secondary  to  other  diseases  must  be  treated 
in  conjunction  with  them.  Cases  resulting  from  gunshot  wounds  and  other 
traumatism  are  surgical  cases.  In  the  acute  case  the  patient  should  be  seen 
two  or  three  times  per  day  as  long  as  the  severe  acute  symptoms  predomi- 
nate. 


JAUNDICE. 

Definition: — A  condition  in  which  bile  is  absorbed  into  the  circula- 
tion and  colors  the  tissues  of  the  body  and  the  secretions. 

Cases:  (i)  Lesion  from  overexertion  in  the  form  of  a  "twist"  between 
the  6th  and  7th  dorsal  vertebrae.  Jaundice  followed  immediately  after  its 
occurence.  (2)  9th  and  loth  dorsal  \ertebrae  anterior;  intense  congestion 
of  the  deep  muscles  of  the  right  cervical  region;  looseness  of  the  7th  cervi- 
cal vertebra.  (3)  Catarrhal  jaundice  following  difficult  childbirth;  extreme 
tenderness  of  the  spine  from  the  loth  dorsal  to  the  is'c  lumbar. 

Lesions  afid  causes:  — Sp'\na\  \es\on  anywhere  along  the  splanchnic  area 
has  been  known  to  produce  the  disease.  Lesion  of  the  lower  right  ribs  is 
common.  Prolapsus  of  the  transverse  colon,  due  to  various  lesions  (see  In- 
testinal Obstruction  and  Enteroptbsis),  may  obstruct  the  duct  by  compres- 
sion. Various  mechanical  causes;  stricture,  gall-stones,  parasites,  tumors, 
etc.,  are  well  known  as  causes  of  obstructed  bile-flow,  leading  to  jaundice. 
The  relation  of  lesion  to  these  causes,  osteopathicall)',  is  found  in  the  agency 
of  various  lesions,  whose  nature  and  action  are  well  undersood  from  discus- 
sions in  the  previous  pages,  in  producing  diseased  conditions  of  the  gastro- 
intestinal tract  leading  to  the  presence  of  such  obstructive  agents. 

Anatomical  Relations: — The  relation  between  spinal  and  other  lesion 
and  abnormal  liver  conditions  have  been  discussed  (see  Cirrhosis  and  Gall- 
stones). In  catarrhal  jaundice,  the  usual  form  presented  for  treatment  as 
jaundice,  lesion  has  occurred  in  the  splanchnic  area  and  is  interfering  with 
vaso-motor  activity  of  the  gastro-intestinal  tract,  producing,  or  allowing 
other  causes  to  produce,  an  inflamed  condition  of  the  mucous  membrane  of 
the  gastro-duodenal  mucosa  and  of  the  mucous  lining  of  the  ductus  com- 
munis. 

The  immediate  appearance  of  jaundice  after  spinal  lesion,  as  in  case  i 
cited  above,  as  well  as  the  presence  of  spinal  lesion  in  other  cases   of  jaun- 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF   OSTEOPATHS.  I25 

dice,  favors  the  probability  of  direct  interference  of  such  lesion  with  the  in- 
nervation of  the  gall-bladder  and  duct.  The  presence  in  the  sympathetic 
supply  of  the  liver  (hepatic  and  cystic  plexuses.  See  Gall-Stones)  of  spinal 
fibres  which,  upon  stimulation  or  inhibition  of  the  spianchnics,  cause  con- 
striction or  dilatation  of  the  bladder  and  ducts;  also  the  fact  that  stimula- 
tion of  the  pneumogastrics  constricts  the  bladder  while  relaxing  the  sphinct- 
er of  the  opening  of  the  common  duct  into  the  duodenum,  make  it  probable 
that  certain  lesion  to  the  splanchnic  area  or  to  the  pneumogastric,  directly 
or  indirectly  through  its  sympathetic  connections,  might  so  pervert  the 
normal  workings  of  this  mechanism  as  to  lead  to  retention  of  bile,  i.  e.,  a 
form  of  obstructive  jaundice. 

The  Prognosis  is  good.  The  acute  case  yields  immediately  to  treat- 
ment. The  usual  course  (two  to  eight  weeks)  is  materially  shortened.  In 
tht.  chronic  case,  clearing  of  the  tissues  from  the  pigmentation  is  rather  a 
slow  process. 

The  Treatment  must  look  at  once  to  the  removal  as  such  active  lesion 
as  described  above.  Mechanical  obstructions  must  be  located  if  possible, 
and  removed  by  work  upon  the  duct,  proceeding  upon  the  lines  laid  down 
for  the  manipulative  removal  of  gall  stones  and  of  intestinal  obstructions, 
q.  V,  Prolapsus  of  the  intestines  and  pressure  from  surrounding  organs 
must  be  relieved  (see  Enteroptosis). 

In  catarrhal  jaundice  the  first  step  must  be  to  gain  vaso-motor  control 
and  relieve  the  inflammation.  A  peliminary  inhibition  of  the  splanchnic 
area  of  the  spine  may  be  necessary  to  relieve  pain  and  to  gain  a  degree  of 
relaxation  of  abdominal  tissues  before  local  work  is  attempted.  Next,  slow, 
deep,  inhibitive  or  relaxing  treatment  is  directed  to  the  upper  intestinal 
region  and  ductus  communis.  This  relieves  the  inflammation,  aids  in  tak- 
ing down  the  swelling  of  the  mucous  membrane,  and  frees  the  secretion  of 
mucous  which  miy  be  obstructing  the  duct.  At  the  same  time,  treatment  of 
the  splanchnics  aids  in  correcting  circulation  in  the  parts. 

After  treatment  for  the  inflammation  and  relaxation  of  the  duct,  the 
next  step  is  the  emptying  of  the  gall-bladder  and  hepatic  ducts.  This  is 
done  by  local  manipulation  which  acts  mechanically  and  by  stimulation  of 
the  hepatic  and  cystic  plexuses.  The  patient  lies  upon  his  back  and  the 
operator  stands  at  the  left  side;  he  places  the  palm  of  the  right  hand  be- 
neath the  postero-lateral  aspect  of  the  lower  four  right  ribs  and,  while  rais- 
ing them,  presses  down  upon  their  anterior  portions  with  the  right  forearm. 
At  the  same  time  the  left  hand  makes  careful  but  deep  pressure  beneath 
the  tip  of  ninth  rib,  against  the  fundus  of  the  gall-bladder.  This  mechanic- 
ally empties  the  liver  and  ducts.  It  also  stimulates  the  local  cystic  plexus 
to  cause  constriction  of  the  bladder  and  ducts. 

This  same  treatment,  and  the  lower  costal  treatment  (V.  Chap.  VIII). 
carefully  applied,  are  given  to  regulate  the  circulation  through  the  liver 
and  to   free   it  of  accumulated  bile.     The  splanchnics  should  also  be  thor- 


126  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

o-ughly  treated  for  the  circulation.  By  these  treatments  the  flow  of  bile  is 
increased,  and  the  system  is  cleared  of  it.  Thorough  stimulation  of  the 
kidneys  and  skin  (2d  dorsal,  5th  lumbar)  aids  in  freeing  the  blood  of  the 
bile  acids.  This  allays  the  itching.  The  superior  cervical  region  (medulla) 
should  be  inhibited  to  correct  general  vaso-motor  action.  This  is  for  the 
itching  and  localized  sweating.  The  bowels  and  stomach  must  be  treated 
to  relieve  the  constipation  or  diarrhoea,  and  the  dyspepsia,  as  before  direct- 
ed.    Other  symptoms  may  be  allayed  by  appropriate  treatment. 

The  diet  should  be  plain,  avoiding  pastry,  starchy,  fatty,  and  saccharine 
foods.  Plenty  of  water  should  be  drunk;  lemonade  and  alkaline  drinks  are 
allowed, 


CONGESTION  OF  THE  LIVER. 

Definition: — An  excess  of  blood  in  the  vessels  of  the  liver.  In  active 
congestion,  or  acute  byperemia,  an  excess  of  arterial  blood  is  circulating 
through  it.  In  passive  congestion  the  liver  is  engorged  by  retention  of 
blood  in  its  portal  circulation. 

The /t'^w/.?  alread)' discussed  in  connection  with  liver  diseases,  i.  e., 
these  of  the  splanchnic  area  and  of  the  lower  ribs,  interfering  with  the  vaso- 
motor control  of  the  organ,  lead  to  the  congestion,  Heart  and  liverdiseases 
are  said  to  be  almost  always  the  causes  of  passive  congestion.  The  lesions 
here  must  be  sought  according  to  the  case,  and  treatment  made  as  thus  in- 
dicated. 

The  Prognosis  is  good.     These  cases  are  usually  readily  cured. 

The  Treatment  is  merely  one  to  gain  vaso-motor  control.  Thorough 
stimulation  of  the  splanchnic  area,  and  solar  and  hepatic  plexuses  are  im- 
portant means  of  accomplishing  this.  The  lower  costal  and  direct  liver 
treatment  indicated  for  jaundice,  q.  v.,  are  used.  Besidesjdirectly  stimulat- 
ing the  local  ner\  e-mechanism,  these  treatments,  by  squeezing  the  liverand 
mechanically  forcing  the  blood  into  and  out  of  it,  cause  the  mechanical 
action  of  the  blood  upon  the  vessel  walls  to  still  further  arouse  vaso-motor 
activity.  Local  treatment  should  be  made  upon  the  liver  to  stimulate  the 
flow  of  bile  and  prevent  jaundice.  A  general  spinal,  neck,  and  abdominal 
treatment  aids  in  correcting  general  circulation.  Treatment  for  the  abdom- 
inal vessels  aids  the  work.  Inhibiting  the  splanchnics,  solar  plexus,  and 
abdominal  vessels  quiets  active  congestion  by  dilating  the  abdominal  vessels 
and  drawing  the  blood  to  them. 


CIRRHOSIS  OF  THE  LIVER. 

Definition:     A  chronic  disease,  characterized  by  an  increase   of  con- 
nective tissue  in  or  about  the  liver. 

Cases:     (i)  Atrophic  cirrhosis;  a  case  brought  on  by  social    drinking^ 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  12/ 

diagnosed  and  treated  by  ph^'sicians  as  such.  The  first  tapping  of  the  ab- 
domen brought  eight  and  one-half  quarts  of  fluid.  The  case  now  came  un- 
der osteopathic  treatment  and  it  succeeded  so  well  that  a  second  tapping 
was  delayed  some  days  beyond  the  expected  time.  Later  a  third  tapping 
beceme  necessary,  but  after  that  none  was  required.  Under  the  treatment 
the  patient  was  apparently  restored  to   perfect  health. 

(2)  Diagnosis  of  cirrhosis;  6th  and  7th  dorsal  vertebrae  posterior,  9th 
to  I2th  flat;  ribs  irregular  and  prominent  on  left. 

(3)  Malarial  cirrhosis;  entire  lumbar  region  bad.  nth  rib  on  each 
side  down. 

(4)  Lesions  and  Causes:  The  lesions  commonly  found  in  these  cases 
affect  the  splanchnic  area,  the  lower  ribs  on  each  side,  or  the  lower  right 
ribs.  The  latter  may  cause  mechanical  pressure  and  irritation  upon  the 
liver.  The  various  lesions  weaken  the  vaso-motor  sjmpathetic  supply  and 
lay  it  liable  to  the  action  of  special  causes  of  the  disease. 

In  those  forms  of  cirrhosis  in  which  ascites  develops,  the  contraction 
of  the  connective  tissue  causes  pressure  upon  the  soft  walls  of  the  branches 
of  the  portal  vein.  Upon  this  account,  and  because  of  the  low  pressure  of 
the  blood  in  the  portal  system,  obstruction  soon  follows,  and  ascites  results. 

The  Prognosis  must  be  guarded  in  all  cases.  Various  cases  ha\e  been 
cured,  among  them  even  atrophic  cirrhosis.  In  the  latter  case  the  prog- 
nosis is  very  unfavorable.  It  is  probnble  that  other  forms  of  the  disease 
can  be  much  benefitted  or  cured  under  the  treatment  in  many  instances. 

The  Treatment  aims  at  gaining  vaso-motor  control  and  thus  taking 
down  the  inflammatory  or  congestive  process  that  is  allowing  of  the  in- 
crease in  connective  tissue.  In  those  forms  complicated  with  ascites  as  the 
main  symptom,  special  attention  mCist  be  given  to  it  as  being  mosi  immedi- 
ately dangerous  to  the  patienf's  life.  (See  Ascites.)  It  is  doubtful  if  con- 
nective tissue,  once  formed,  could  be  absorbed  by  the  renewed  blood-sup- 
ply. But  the  process  of  its  formation  could  be  stopped,  the  liver  substance 
could  be  kept  softened  by  thorough  work  locally  over  the  organ,  thus  pre- 
venting hardening  and  contraction  of  it,  and  maintaining  freedom  of  circu- 
lation through  it.     In  this  way  danger  of  ascites  could  be  avoided. 

Vaso-motor  control  is  gained  by  removal  of  lesion,  by  thorough  stimu- 
lation of  the  splanchnic  area  of  the  spine,  and  by  local  abdominal  work 
over  the  liver  and  over  the    course  of  the  portal  vein. 

Local  work  may  be  done  as  described  in  V,  Chap.  VIII,  workieg  be- 
neath the  right  ribs,  directly  upon  the  liver,  while  the  pressure  from  above 
upon  the  ribs,  pressing  them  down  upon  the  liver,  alternating  with  that 
applied  directly  to  the  liver,  is  an  efficient  mode  of  stimulating  the 
organ  directly. 

In  atrophic  cirrhosis  attention  must  be  given  to  relieving  the  conges- 
tion of  the  spleen,  stomach  and  intestines  present.  This  is  done  through 
treatment  of  the  organs  as  described  in  considering  diseases    of   them.     In 


128  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

case  of  the  spleen  only  slight  treatment  should  be  made  over  it  locally  on 
account  of  danger  of  rupture.  Stimulation  of  the  lower  splanchnic  area 
and  raising  the  lower  four  left  ribs,  together  with  work  upon  the  solar 
plexus  and  the  abdominal  circulation  are  sufficient  for  it.  The  constipa- 
tion, gastric  catarrh,  nausea,  vomiting,  edema  of  the  lower  extremities,  etc., 
are  treated  as  before  described. 

In  biliary  cirrhosis,  the  chief  object  of  treatment  is  to  remove  the  ob- 
struction to  the  duct  and  to  empty  the  gall  bladder.  (IX,  Chap.  VIII.) 
The  general  corrective  treatment  for  the  liver  as  described  is  relied  upon 
to  soften  the  new  tissue  about  the  small  ducts  and  to  prevent  its  further 
formation. 

In  congestive  and  malarial  cirrhosis  the  chief  point  is  to  remove  and 
prevent  the  congestion.  Otherwise  the  treatment  is  as  indicated  for  the 
general  case. 

In  all  cases  the  general  treatment  outlined,  with  attention  to  the  special 
symptoms  manifested,  should  be  applied. 

In  acute  cases  the  patient  should  be  seen  daily. 


GALL-STONES. 

Definition':  Concretions  in  the  gall  bladder,  chiefly  of  cholesterin 
due  to  a  pathological  process  usually  caused  by  spinal  lesion  to  sympathet- 
ic nerves  in  charge  of  liver  functions. 

Cases:  Very  numerous  cases  of  gall-stones,  some  of  them  noted,  have 
been  successfully  treated.  It  is  one  of  the  most  common  things  treated, 
and  in  no  class  of  cases  have  more  uniformly  good,  even  striking,  results 
been  attained. 

The  Lesions  found  in  these  cases  are  usually  low  down  in  the  splanch- 
nic area,  affecting  the  lower  four  ribs  upon  either  side,  ver\-  frequently  upon 
the  left,  for  the  spleen.  Lesions  of  the  nth  and  I2th  vertebrae  may  not  be 
too  low  to  cause  it.  However,  any  of  those  lesions  to  the  ribs  and  splanch- 
nic area,  characteristic  of  bad  gastro-intestinal  conditions  may,  from  the 
nature  of  the  case,  affect  the  liver  to  produce  gall-stones.  The  liver  is  in- 
nervated from  the  same  nerve  supply,  gastro-intestinal  diseases  are  usually 
complicated  with  deranged  liver  function,  and  it  is  reasonable  to  find  in  the 
usual  lesions  deranging  the  activities  of  the  former  a  sufficient  cause  for  dis- 
ease in  the  latter,  which,  owing  to  some  particular  form,  degree,  or  concen- 
tration of  lesion,  results  in  cholelithiasis. 

Anatomical  Relations  of  lesion  to  disease:  The  liver  is  supplied  by 
the  splanchnics  through  the  solar  plexus,  the  secondary  plexus,  the  hepatic, 
in  the  formation  of  which  the  left  pneumogastric  nerve  participates,  having 
special  charge  of  the  liver  activities.  Its  branches  ramify  throughout  the 
liver  upon  the  branches  of  the  portal  vein  and  the  hepatic  artery,  the  chief 
supply  being  to  the  latter.     The  blood-supply  from  both  of  these  sources  is 


PRACTICE  AND  APPI.IRD  THERAPBUTICS  OF  OSTEOPATHY.  1 29 

thought  to  be  essential  to  the  activities  of  the  liver  cells.  The  nutrien* 
blood-supply  (hepatic)  is  chiefly  supplied  by  branches  of  the  sympathetic. 
A  cystic  plexus  of  the  sympathetic  supply  is  spread  upon  the  gall-bladder 
and  bile-ducts.  The  American  Text  Book  of  Physiology  states  that  special 
investigation  has  shown  that  these  nerves  are  similar  in  function  to  vaso- 
constrictor and  vaso  dilator  nerves,  and  that  stimulation  of  the  peripheral 
end  of  the  cut  splanchnics  causes  a  contraction  of  the  bile-ducts  and  gall- 
bladder, while  stimulation  of  the  cut  end  of  the  same  nerve  causes  reflex  di- 
latation. According  to  the  same  investigator,  stimulation  of  the  central 
end  of  the  vagus  nerve  causes  contraction  of  the  gall-bladder  and  at  the 
same  time  an  inhibition  of  the  sphincter  muscle  closing  the  opening  of  the 
common  bile-duct  into  the  duodenum. 

These  interesting  and  instructive  facts  cannot  but  be    of    much    signifi 
cance  to  the  Osteopath.     Doubtless  he  could   not  avail  himself  of  these  de 
tailed  facts  to  manipulate  at  will  the  activities  of  the  biliary  apparatus,    but 
spinal  and  other  lesions  affecting  the  sympathetic  connections  of  the  organs 
must  be  efficient  causes  in  producing  abnormal  function. 

Osier  states  that  any  cause,  such  as  tight-lacing,  bending  forward  at  a 
desk,  enteroptosis,  etc.,  which  produce  stagnation  of  bile  favors  cholelithia- 
sis. From  an  osteopathic  standpoint,  and  in  view  of  the  above  facts,  it  is  a 
reasonable  conclusion  that  certain  spinal  lesion,  acting  through  this  nerve- 
mechanism  above  described,  may  cause  a  stimulated,  irritated,  or  over-ac- 
tive condition  of  the  dilator  fibers  of  the  ducts  and  gall-bladder,  thus 
maintaining  a  permanent  dilated  or  sluggish  condition  of  the  apparatus, 
favoring  stagnation  of  the  bile  and  the  formation  of  gall-stones.  Likewise 
one  must  concede  the  possibility  of  lesion  to  the  central  end  of  the  vagus 
nerve,  cutting  off  the  normal  impulses  through  the  nerve  which  contract 
the  gall-bladder  and  relax  the  sphincter  of  the  common  duct,  thus  allowing 
of  a  lack  of  normal  contraction  of  the  bladder  and  opening  of  the  duct;  in 
other  words,  favoring  a  sluggish  condition  of  the  biliary  apparatus  leading 
to  retention  and  stagnation  of  bile,  thus  to  cholelithiasis.  If  any  osteo- 
pathic spinal  lesion  can  interfere  with  sympathetic  viscereal  supply,  a  point 
placed  beyond  controversy  by  demonstrated  facts,  it  is  a  reasonable  con- 
clusion that  spinal  lesion  to  the  sympathetic  supply  to  the  liver  can  become 
the  cause  of  gall-stones  in  this  way. 

According  to  the  catarrhal  theory  of  the  formation  of  gall-stones,  litho- 
genous  catarrh  of  the  mucosa  of  the  bladder  and  duct  modifies  the  chemical 
constitution  of  bile  and  favors  the  deposition  of  cholesterin  about  some  nu- 
cleus, such  as  epithelial  debris.  Cholesterin  and  lime  salts  are  produced  by 
the  inflamed  mucous  membrane  to  form  the  calculus.  As  shown  above, 
both  the  hepatic  and  portal  blood-supply  is  under  control  of  the  hepatic 
plexus,  i.  e.,  of  the  solar  plexus  and  the  splanchnics.  According  to  the 
American  Text-Book  of  Physiology,  stimulation  or  inhibition  (section)  of 
the  splanchnics  produces  at  once  vaso-constriction  or  vaso-dilatation  of  the 


130  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV. 

blood-vessels  of  the  liver.  Here,  as  in  the  case  gastric  or  intestinal  catarrh, 
spinal  lesion  to  the  splanchnics  could  disturb  vaso-motor  equilibrium  in  the 
liver  and  cause  catarrh  of  the  mucous  membrane. 

It  is  the  practice  of  Osteopaths  to  give  close  attention  to  the  condition 
of  the  spleen  in  case  of  gall-stones.  Important  lesions  to  this  organ  are 
often  found  in  such  cases  (8th  to  12th  left  ribs,  A.  T.  Still)  Removal  of 
this  lesion  seems  to  prevent  further  formation  of  the  calculi.  What  influ- 
ence the  spleen  naturally  exerts  upon  the  liver  is  not  known.  The  splenic 
and  superior  mesenteric  veins  unite  to  form  the  portal  vein.  The  abundant 
venous  flow  from  the  spleen  is  carried  directly  to  the  liver  in  the  portal 
circulation.  The  American  Text-Book  shows  that  there  is  little  doubt  that 
the  materials  actually  utilized  by  the  liver  cells  in  forming  their  secretions 
are  brought  to  them  mainly  b}-  the  portal  vem.  The  blood  which  has  cir- 
culated through  the  spleen  must  compose  an  important  part  of  the  blood 
brought  by  the  portal  vein  to  the  liver.  It  may  be  that  certain  products  of 
splenic  activity  are  useful  in  maintaining  the  fluidity  of  the  cholesterin  and 
in  preventing  the  formation  of  gall-stones.  The  spleen  is  enlarged  and 
tender  in  this  case. 

Sensory  nerves  pass  through  the  sympathetic  from  the  (6th?)  7th,  8th, 
9th  and  lOth  spinal  nerves  (Quain)  This  fact  may  explain  the  radiation  of 
the  pain  in  hepatic  colic  to  the  spine  and  right  shoulder,  and  forms  a  good 
anatomical  reason  why  inhibition  over  this  spinal  region  will  aid  in  stopping 
the  pain. 

The  Prognosis  is  good,  even  in  serious  cases  in  which  operation  has 
seemed  advisable.  The  case  is  frequently  presented  to  the  Osteopath  as 
the  last  resort  before  operation,  and  results  have  been  almost  uniformly 
good. 

Treatment:  The  success  of  the  treatment  seems  to  rest  mainl)-  upon 
the  mechanical  effect  and  upon  the  relaxation  of  all  tissues  concerned, 
gall-ducts  included,  gained  by  the  use  of  osteopathic  methods.  The  main 
treatment  in  these  cases  is  locall)-  about  the  region  of  the  liver;  as  much  of 
the  relaxing  and  inhibitive  treatment,  and  the  main  work  of  removing  the 
stone  are  done  here.  Spinal  work  is  important,  as  here  inhibition  for  the 
pain  of  the  colic  is  made,  lesion  is  corrected,  and  circulation  is  stimulated. 
Nervous  control  is  an  important  factor  in  the  treatment.  It  is  gained  by 
both  spinal  and  abdominal  work,  perhaps  alone  by  the  removal   of  lesion. 

The  objects  of  the  treatment  are:  (i)  To  remove  the  stone.  (2)  To 
restore  normal  liver  function  and    prevent  further  formation  of  stones. 

The  former  is  palliative  treatment;  the  latter  is  the  real  curs. 

In  the  acute  case,  \i  colic  is  present  the  first  step  is  to  make  strong  in- 
hibition over  the  7th  to  loth  spinal  nerves.  (Some  say  upon  the  right  side.) 
This  will  lessen  or  stop  the  pain  and  allow  of  work  upon  the  abdomen. 
This  is  deep,  relaxing,  inhibitive  work  upon  the  tensed  abdominal  walls, 
over  the  epigastric  and  lower  anterior  thoracic  regions,  and  over  the  course 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I3I 

of  the  duct  (IX,  Chap.    VIII.)     The  pain  is  usually  relieved  in  a  few    min- 
utes. 

The  stone  is  removed  by  working  it  along  the  duct  after  the'preliminary 
relaxing  treatment.  The  patient  should  He  upon  his  back  with  knees  flexed 
and  shoulders  slightly  raised.  The  lower  ribs  are  raised  by  inserting  the 
fingers  beneath  their  anterior  edges,  and  manipulation  is  made  deeply  over 
the  site  of  the  fundus  of  the  gall-bladder  (tip  of  gth  rib)  and  down  along 
the  course  of  the  duct.  The  latter  may  vary  from  its  course  on  account  of 
sagging  of  the  intestines  sometimes  found.  This  treatment  must  be  thor- 
ough and  persistent.  It  should  be  firmly  and  deeply,  but  most  carefully 
applied.  Sometimes  a  few  minute's  work  will  pass  the  stone,  but  often  con- 
tinued treatment  for  three-quarters  of  an  hour  or  an  hour  must  be  devoted 
to  it.  Only  careful  manipulation  could  be  borne  by  the  patient  for  this 
length  of  time.  As  long  as  the  stone  remains  in  the  duct  and  causes  the 
colic  the  attempt  to  remove  it  should  be  continued,  though  it  may  not  be 
advisable  to  treat  continuously  all  of  the  time.  The  stone  may  or  may  not 
be  large  enough  to  be  felt  in  the  duct.  Stones  are  often  passed  without 
pain.  Some  stones  are  soft  and  may  be  carefully  broken  down  by  the 
treatment. 

The  spleen  is  treated  by  careful  abdominal  work  over  and  beneath  the 
lower  left  rib,  anteriorly.  It  is  chiefly  affected  by  treatment  to  the  splanch- 
nics,  raising  the  lower  right  ribs  (8th  to  12th),  and  removal  of  lower  spinal 
and  rib  lesion. 

T\\^  jaundice,  if  intense,  indicates  impaction  of  the  stone  in  the  com- 
mon duct.  Its  cure  depends  upon  the  removal  of  the  stone.  The  kidneys 
should  be  kept  active. 

Fever,  if  present  is  alla)'ed  in  the  usual  manner.  Fatal  syncope  some- 
times occurs.  If  imminent  the  patient  should  be  fortified  against  it  by  thor- 
ough stimulation  of  the  heart.  Yox  obstniction  of  bowelhy  calculi,  see  In- 
testinal Obstruction. 

A  dilaled gall-bladder  and  duct  are  treated  locally  by  manipulation  to 
remove  the  obstruction  as  for  removal  of  the  stone.  Thorough  treatment 
must  be  given  the  liver  locally  and  thorough  spinal  treatment  must  be  kept 
up  for  the  purpose  of  circulation,  etc. 

According  to  Dr.  A.  T.  Still  the  lesion  of  the  6th  to  lO  left  ribs  found  in 
cases  of  gall-stones  is  obstructing  pancreatic  secretions.  These,  he  says, 
dissolve  gall-stones. 


ASCITES. 

■     Definition: — A  dropsical  condition  of  the  abdomen,  due  to  an  accumu- 
lation of  serous  fluid  in  the  peritoneal  sac. 

The  Lesions  in  these  diseases  are  various,  as  it  is  commonly  a  condition 
secondary  to  some  other  disease,  as  of  the  heart,  lungs,  kidneys,  liver,    etc. 


132  PRACTICE  AND   APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

Lesions  must  be  expected  according  to  the  nature  of  the  primary  disease. 
If  i»:  be  due  to  a  local  condition,  such  as  obstructed  portal  circulation  (see 
Cirrhosis  of  the  Liver),  peritonitis,  q.  v.,  or  abdominal  tumor,  the  lesions 
expected  are  the  ones  usually  found  in  these  conditions.  Lesions  in  the 
splanchnic  area,  the  upper  lumbar  region,  and  among  the  lower  ribs  occur 
often  in  these  cases  as  underlying  causes,  determining  the  local  manifesta- 
tion of  the  disease  through  interference  with  the  sympathetic  innervation 
of  the  abdominal  vessels,  as  before  explained. 

The  vast  area  and  capacity  of  the  abdominal  veins,  the  ease  with  which 
they  are  dilated,  and  the  relation  of  the  portal  circulation  to  the  liver,  to- 
gether with  the  frequent  presence  of  lesions  in  the  splanchnic  and  upper 
lumbar  regions  of  the  spine,  weakening  vaso-motor  control  of  these  vessels 
are  no  doubt  important  anatomical  factors  in  determining  the  drops)-  to  the 
abdominal  region. 

The  Prognosis  in  these  cases  depend  upon  that  for  the  condition  produc- 
ing the  trouble.  Generally  speaking,  it  is  good  except  in  cases  of  atrophic 
cirrhosis  of  the  liver, 

The  Treatment  for  ascites  consists  chiefly  in  the  treatment  of  the  dis- 
ease to  which  it  is  secondarj'.  Special  lesion  as  found  must  be  removed. 
Obstructed  circulation  must  be  opened,  general  abdoininal  circulation  stimu- 
lated, and  the  collateral  circulation  through  the  superficial  abdominal  veins 
developed.  This  is  accomplished  by  spinal  correction  and  stimulation  of 
the  splanchnic  and  lumbar  vaso-motor  areas.  The  solar  and  other  abdomi- 
nal plexuses  are  stimulated,  and  deep  abdominal  manipulation  is  made  from 
below  upward  along  the  course  of  the  vena-cava  and  azygos  veins,  the  portal 
vein,  and  the  superficial  abdominal  veins.  Thorough  stimulation  of  the 
liver  and  portal  circulation  is  the  most  important  factor  in  the  treatment  of 
this  condition.  (See  Cirrhosis  of  the  Liver.)  Treatment  over  the  course 
of  the  superficial  abdominal  veins  results,  in  the  course  of  a  few  treatments, 
in  considerable  enlargement  of  them.  As  circulation  is  corrected  the  drop- 
sical process  is  checked,  and  absorbption  of  fluid  already  effused  begins  to 
take  place.  Stimulation  of  kidnej's,  bowels,  and  skin  aid  the  process.  The 
distention  of  the  abdomen  may  considerably  hinder  the  treatment.  By 
laying  the  patient  upon  his  side,  so  that  the  fluid  gravitates  away  from  the 
uppermost  side,  the  latter  may  be  treated  by  deep  manipulation.  The  pati- 
ent may  then  be  laid  on  the  other  side,  and  the  process  be  repeated.  On 
account  of  the  accumulation  of  fluid  paracentesis  may  have  to  be  perform- 
ed, but  ordinarily  under  osteopathic  treatment  tapping  does  not  become 
necessar}-,  except  in  cases  of  atrophic  cirrhosis  of  the  liver.  The  lower 
limbs  should  be  treated  to  increase  circulation  in  them  and  to  empty  their 
■dilated  veins. 

The  patient  should  be  treated  daily. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  I33 


DISEASES  OF  THE  LIVER.     Continued. 

Cases:  (i)  Heptic  abscess,  complicated  with  gastric  ulcer.  Lesions 
at  the  3rd  cervical,  and  at  the  4th,  5th,  and  8th  dorsal;  rigid  spinal  muscles; 
7th  to  lOth  right  ribs  overlapped.  The  case  was  in  a  very  serious  condition^ 
but  began  to  improve  after  two  weeks,  and  was  finally  cured  by  the  treat- 
ment. (2)  A  case  of  hypertrophy  of  the  liver;  the  organ  was  restored  to 
normal  size  and  function  in  one  month's  treatment.  (3)  Torpid  liver,  with 
chronic  gastritis;  marked  lesion  at  4th  and  5th  dorsal;  slight  lesion  at  the 
9th  dorsal  cured. 

For  Hepatic  Abscess  the  prognosis  must  be  guarded  and  unfavorable. 
While  limited  quantities  of  pus  may  be  effectually  and  safely  absorbed 
through  increased  circulation,  any  large  quantity  could  probably  not  be 
thus  disposed  of.  Some  cases  have  been  cured  by  osteopathic  treatment, 
and  there  are  some  chances  of  curing  the  ordinary  case  presented  for  treat- 
ment. The  fact  that  the  disease  has  and  can  be  cured  warrants  thorough 
trial. 

The  Treatment  must  be  to  absorb  the  pus  and  heal  the  ulcer  through 
increased  circulation  of  the  blood.  Removal  of  lesion  is  naturally  the  im- 
portant step  in  this  process,  as  it  is  obstructing  proper  circulation  and  in- 
nervation. The  usual  lesions  in  liver  diseases  must  be  expected.  Full 
directions  have  been  given  for  treatment  of  circulation  to  the  liver.  Great 
care  must  be  taken  in  local  treatment  over  the  liver  because  of  danger  of 
rupturing  the  abscess.  Pain,  if  present,  is  quieted  as  before.  Attention 
must  be  given  to  the  gastro-intestinal  disorders;  constipation  and  diarrhoea. 
As  abscess  is  frequently  secondary  to  some  other  disease,  treatment  must 
be  made  accordingly  in  such  cases.  A  bronchial  cough,  frequently  present, 
may  be  guarded  against  by  stimulation  of  the  vaso-motors  to  the  lungs. 

Hyhertrophy  of  the  Liver  is  frequently  presented  for  treatment,  and 
as  a  rule  good  results  are  gotten.  Many  cases  are  cured.  Many  cases  can- 
not, from  their  nature,  be  cured.  Complete.restoration  of  size  and  function 
often  results  from  the  treatment.  In  many  other  cases,  while  the  size  can- 
not be  reduced  to  normal  limits,  function  is  restored.  The  general  prog- 
nosis is  favorable.  In  true  hypertrophy  due  to  increase  of  connective  tissue 
the  new  tissue  can  probably  not  be  absorbed,  but  the  further  increase  of  it 
may  be  checked  and  the  function  usually  restored. 

In  true  hypertrophy  due  to  increase  in  size  or  number  of  the  parenchy- 
matous cells,  the  treatment  may  reduce  their  size  or  number,  and  normal 
size  and  function  of  the  liver  is  restored.  As  the  chief  causes  of  true  hyper- 
trophy are  active  and  passive  congestion  (lesion  to  the  vaso-motors),  good 
results  follow  corrected  circulation. 

In  false  hypertrophy  due  to  cancer  or  abscess,  little  is  expected  in  the 
way  of  reduction.     When  due  to  fatty  infiltration,  the  renewed  circulation 


134  PRACTICE  \ND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

removes  the  accumulated  fatty  particles  and  restores  normal  size  and  func- 
tion. The  treatment  in  these  cases  consists  in  the  removal  of  lesion  and 
correction  and  stimulation  of  circulation.  When  secondary,  the  primary 
disease  is  treated. 

In  fatty  degeneration  of  the  liver  good  results  may  be  expected  from 
the  treatment.  Recorded  facts  are  lacking,  as  they  are  also  in  regard  to 
amyloid  degeneration,  cancer,  and  acute  yellow  atrophy,  of  the  liver. 


SPLENITIS. 

Definition:  Acute  or  chronic  proliferative  inflammation  of  the  spleen. 
Suppuration  may  occur. 

Case:  Lady,  fifty  years  of  age,  suffering  from  chronic  inflammation  of 
the  spleen.  Spleen  was  much  enlarged,  and  she  was  unable  to  wear  corsets. 
Lesion  was  found  in  the  form  of  a  misplaced  rib  pressing  upon  the  spleen. 
Its  replacement  caused  the  pain  to  disappear,  and  the  waist  measured  two 
inches  less  the  next  morning.     The  case  was  cured  in  one  month. 

Lesions  occur  in  downward  and  forward  luxations  of  the  6th  to  12th 
left  ribs.  ,  (A.  T.  Still).  Diaphragmmatic  lesion  thus  caused  may  interfere 
with  position,  circulation,  or  innervation  of  the  organ.  Direct  pressure  of 
a  misplaced  rib  may  irritate  the  organ,  or  Iherib  may,  by  interference  with 
spinal  innervation,  cause  the  trouble. 

Anatomical  Relations:  Stimulation  of  the  peripheral  end  of  the 
splanchnics  causes  sudden  and  large  diminution  of  the  volume  of  the  spleen. 
It  is  probable  that  this  diminution  is  due  to  contraction  of  its  trabeculae 
and  capsule,  which  are  plentifully  supplied  with  involuntary  muscle  fibres. 
*'The  organ  is  richly  supplied  with  nerve-fibres  which,  when  stimulated 
directly  or  reflexly,  cause  the  organ  to  diminish  in  volume"  (American  Text 
Book  of  Physiology).  According  to  Schafer,  these  fibres  are  contained  in 
the  splanchnics,  which  carry  also  inhibitory  fibres  whose  stimulation  causes 
dilatation  of  the  spleen. 

In  view  of  these  facts  it  seerfis  that  treatment  over  the  splanchnic  area 
of  the  spine  and  locally  over  the  spleen  may  produce  changes  in  its  volume 
(^through  thus  directly  or  indirectly  stimulating  these  nerve-connections) 
which  is  most  useful  "n  correcting  circulation  through  it.  In  addition  to 
this,  the  same  work  would  affect  the  vaso-motor  mechanism  of  the  organ. 
The  splenic  plexus,  ramifying  upon  the  splenic  artery  and  upon  its  branches 
throughout  the  spleen,  is  composed  of  sympathetic  fibres  from  the  solar 
plexus  and  of  branches  from  the  right  pneumogastric.  Local  or  spinal 
treatment  affects  these.  It  is  readily  apparent,  in  view  of  the  whole  mech- 
anism described  above,  that  spinal  and  rib  lesion  may  seriously  affect  the 
organ  by  disturbance  of  these  nerve-connections,  producing  inflammatory 
or  congestive  conditions. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  135 

Anders  states  that  splenitis  is  prohably  never  primary,  but  in  the  case 
cited  above  it  seems  that  the  disease  must  have  originated  primarily  in  the 
spleen  by  action  of  the  disturbance  caused  by  the  displaced  rib. 

Treatment:  As  splenitis  and  congestion  are  frequently  secondary  to 
some  other  disease  (malaria,  typhoid,  etc),  such  disease  must  be  treated 
primarily.  Removal  of  lesion,  as  in  the  above  case,  may  be  the  only  treat- 
ment necessary.  Stimulation  or  inhibition  of  the  splanchnics  at  the  spine, 
and  of  the  capsule  and  local  plexuses  by  work'  directly  upon  the  organ, 
is  made.  Care  must  be  taken  in  the  latter  process  to  avoid  danger  of  rupture 
of  the  organ. 

Inhibitive  work  upon  the  splanchnics,  the  solar  plexus,  and  the  abdo- 
men will  dilate  the  abdominal  vessels  and  draw  the  blood  to  them,  away 
from  the  spleen. 

Splenic  Hyperaemia,  active  or  passive,  is  readily  reduced.  Chronic 
cases  may  yield  at  once  or  may  require  a  patient  course  of  treatment.  Con- 
traction of  the  tissues  about  the  splenic  vein  has  been  known  to  cause  great 
enlargement  of  the  organ  by  passive  congestion.  Upon  removal  of  the 
obstruction  the  organ  quickly  returned  to  its  normal  limits.  The  lesions  and 
lreatme?it  dixe.  the  same  as  indicated  for  splenitis. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  137 


DISEASES  OF  THE  URINARY  SYSTEM. 

Cases:  (i)  Lithuria  in  [a  young  girl  after  typho-malaria.  Lesion,  a 
faulty  condition  of  the  lower  dorsal  and  lumbar  regions.  Such  quantities 
of  uric  acid  "sand"  appeared  as  to  be  easily  seen  by  the  naked  eye.  Dr. 
A.  T.  Still  found  a  "hot  spot"  at  the  4th  lumbar  which  was  slipped.  Also 
found  the  loth  right  rib  off  its  articulation  at  its  head,  interfering  with  the 
function  of  the  adrenal  bodies.  In  less  than  two  hours  after  his  treatment 
normal  urine  was  passed.  The  previous  passage,  one  half-hour  before  the 
treatment,  had  been  cloudy,  dark,  and  contained  a  heavy  precipitate. 

(2)  Abscess  of  the  kidney  and  catarrh  of  the  bladder,  of  three  }'ears' 
standing,  in  a  man.  He  was  obliged  to  urinate  every  five  or  ten  minutes, 
always  with  great  pain.  The  urine  was  about  one-half  sediment  and  blood, 
and  only  about  one-half  the  normal  amonnt.  After  six  weeks'  treatment 
the  case  was  almost  well,  no  pain  upon  urination;  retains  urine  one  hour; 
practically  no  sediment;  normal  amount  of  urine. 

(3)  Bright's  disease  in  a  mantwenty-nine  )'ears  of  age;  diagnosis  con- 
firmed by  several  physicians;  great  dropsical  swelling  of  feet,  limbs  and 
body  up  to  the  I2th  dorsal  vertebra.  After  five  weeks'  treatment  he  was 
able  to  go  to  work  at  an  occupation  that  kept  him  constantly  upon  his  feet. 
After  the  fourth  treatment  there  had  been  rapid  improvement;  in  six  weeks 
the  urine  was  almost  normal,  and  the  dropsy  had  disappeared. 

(4)  Retention  of  urine  from  enlarged  prostate,  and  uric  acid  poisoning, 
in  a  man  of  seventy-three  years  of  age.  He  was  about  to  be  operated  up- 
on for  "abdommal  tumor."  The  Osteopath  used  a  catheter  at  once,  and 
drew  about  a  gallon  of  decomposing  urine.  The  next  morning  about  one 
quart  of  urine  was  drawn,  containing  much  blood  and  stringy  mucous.  In 
three  months'  treatment  the  prostate  was  reduced,  and  the  urination  was 
about  normal. 

(5)  Uremic  poisoning  (kidne)'  and  bladder  disease),  in  which  the  pa- 
tient was  m  a  critical  condition;  had  not  slept  for  two  days  on  account  of 
severe  pain.  In  fifteen  minutes  the  pain  was  relieved  by  the  treatment. 
Spinal  lesion  was  found  at  the  centers  for  bladder  and  kidneys.  Great  im- 
provement attended  one  month's  treatment. 

(6)  Chronic  Bright's  disease  after  lagrippe.  The  patient  was  in  a 
very  bad  condition,  being  confined  to  his  room.  After  five  treatments  he 
was  able  to  go  out,  and  was  much  improved  in  one  month. 

(7)  Renal  calculi,  in  which  operation  had  been  advised.  The  patient 
was  kept  in  bed  by  the  great  pain  of  the  colic.  After  two  treatments  the 
patient  was  able  to  go  to  the  of^ce  for  treatment,  and  after  a  third  treat- 
ment had  no  further  trouble. 

(8)  Enuresis.  The  5th  lumbar  vertebra  was  lateral.  The  case  was 
entirely  cured  in  six  weeks  by  the  removal  of  this  lesion. 


138  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

(9)  Chronic  Nephritis  (probably)  diagnosed  as  floating  kidney.  The 
patient,  a  ladv  of  fifty-five,  was  in  a  very  bad  general  condition;  heavy  sed- 
iment in  the  urine;  painful  micturition.  Lesions:  Upper  cervical  lateral; 
posterior  curvature  from  $th  dorsal  to  5th  lumbar;  marked  lesion  at  loth,  nth 
and  I2th  dorsal,  and  2d  lumbar.  The  nth  and  12th  ribs  were  subluxated, 
giving  the  appearance  of  tumor,  diagnosed  as  floating  kidney.  The  case 
began  to  improve  upon  the  first  treatment,  and  was  practicallx'  cured  in  two 

months. 

(10)  Kidney  disease  due  to  double  scoliosis,  6th  to  loth  dorsal  left; 
ist  to  5th  lumbar  posterior.  Treatment  of  the  curvature  improved  the  kid- 
neys. 

(n)  Enuresis  in  a  bo)-  of  seventeen,  of  seven  years'  standing.  Occip- 
ital pains  present.  Tissues  about  2d  cervical  tense;  about  3d  and  4th  cerv- 
ical sore;  7th  and  8th  dorsal  vertebrae  anterior  and  sore.  The  boy  had 
been  thrown  from  a  horse  at  ten  years  of  age,  and  the  trouble  had  persisted 
ever  since. 

(12)  Enuresis  in  a  boy  of  five,  had  been  present  all  his  life.  For  four 
years  he  had  been  constantly  under  medical  care.  He  had  no  warning  of 
the  passage  of  urine,  even  in  the  day  time.  After  eleven  treatments  but 
two  involuntary  passages  occurred  in  eight  months.  After  a  recurrence 
due  to  an  attack  of  the  mumps,  two  weeks'  treatment  cured  the  case.  The 
treatment  was  given  over  the  sacral  and  lumbar  regions. 

(13)  Enuresis  in  a  boy  of  nine.  He  had  been  so  troubled  for  eight 
years  during  sleep.  The  usual  methods  of  treatment  had  been  without 
avail.  Great  tenderness  and  a  slight  lesion  occurred  at  the  2d  lumbar,  re- 
moval of  which  cured  the  case. 

(14)  Eneuresis  in  a  boy  of  twelve  who  had  always  had  poor  health. 
For  eight  years  nocturnal  urination  had  been  constantly  present.  In  the 
day  time  the  urine  passed  involuntarih'.  Lesions  were  found  in  the  cervi- 
cal region;  pronounced  posterior  position  of  the  lower  dorsal  spine;  lesions 
from  the  2d  to  5th  lumbar.  Steady  improvement  took  place  under  treat- 
ment, and  the  case  was  cured  in  three  months. 

(m)       Enuresis  in  a  girl  of  eight  cured  in  five  weeks'  treatment. 

(16)  F'requent  mictuiition,  varicocele  and  weak  e)es  being  [Mesent, 
The  lesions  were  at  the  3d  cervical,  lateral  spinal  curvature,  and  lesion  at 
the  2d  and  4th   lumbar. 

(17)  Acute  Nephritis  in  a  man  of  forty.  Lesion  was  found  irritating 
the  renal  splanchnics.  The  treatment  was  at  the  nth  and  I2lh  dorsal,  and 
raising  of  the  I  ith  and  I2ih  ribs. 

(18)  Acute  Hright's  Disease,  so  diagnosed  by  two  physicians.  Large 
quantities  of  albumen  appeared  in  the  urine  The  I2th  dorsal  vertebra  was 
found  anterior.  One  treatment  relieved  the  pain  and  the  patient  slept. 
Good  progress  was  reported. 

^19)     Acute    Bright's    Disease.    Spinal  lesion  was  found.     After  severe 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I  39 

weeks'  treatment  no  further  sxmptoins  remained.  For  five  weeks  a  ph)'si- 
cian  examined  the  urine  daily  findin<^  no  further  evidence  of  the  trouble  at 
the  end  of  that  time.     He  said  he  had  never  seen  a  case  do  so  well. 

(20)  Bright's  Disease  and  Paraplegia;  lesion  was  found  as  a  separation 
between  the  iith  and  12th  dorsal.  There  was  a  history  of  the  patient's 
having  jumped  from  moving  trains  for  )'ears. 

(21)  Uremic  Poisoning  cured  by  thorough  stimulation  of  the   kidneys. 

(22)  Uremic  Poisoning;  the  case  was  sleepless,  vomiting,  and  near  con- 
vulsions.      Treatment  relieved  the  case  at  once. 

(23)  Enuresis  in  a  boy  of  five.  The  lumbar  region  was  very  weak, 
and  iiad  a  posterior  tendency.     Treatment  here  relieved  the  case. 

(24)  Renal  Calculi.  Severe  attacks  of  colic  had  caused  great  pain 
and  sleeplessness  for  three  days.  Medical  treatment  for  two  days  was  with- 
out avail.  In  the  evening  of  the  third  day  osteopathic  treatment  was  given 
and  the  relief  was  immediate;  The  patient  was  out  of  bed  the  next  morn- 
ing, and  was  cured  in  a  few  treatments. 

(25)  Inflammation  of  the  urinary  meatus.  Constipation  was  preseet. 
There  had  been  congestion  of  the  kidneys  one  year  before.  The  vertebrae 
from  the  2d  to  the  5th  dorsal  were  approximated  and  to  the  right;  those 
from  the  8th  dorsal  to  3d  lumbar  were  separated.  The  right  innominate  was 
displaced  upward  and  backward,  shortening  the  limb. 

(26)  Suppression  of  urine,  the  patient  having  not  urinated  in  fifteen 
hours,  Vv'as  relieved  at  once  by  treatment  at  the  renal  splanchnics  and  upper 
lumbar. 

(27)  Renal  Calculus.  Lesion  was  found  at  the  nth  dorsal.  Inhibit- 
ing treatment  upon  the  renal  splanchnics  lessened  pain.  The  calculus  was 
worked  along  the  course  of  the  ureter  into  the  bladder  and  passed  later. 

lyESiONs:  The  centers  of  importance  osteopathically  in  urinarj-  diseases 
are  generally  stated  as  follows:  ^6th  dorsal  for  kidneys;  12th  dorsal  for 
renal  splanchnics;  2d  lumbar  for  micturition;  3d  and  4th  sacral  for  neck 
and  bladder;  medulla  (sup.  cervical,  atlas)  renal  center;  2d  to  5th  lumbar  / 
(Am.  Text  Bk.  Physiol  )  urino-genital  (or  genito-spinal)  center  for  bladder; 
peritoneal  sympathetic  centers,  each  side  of  the  umbilicus  for  the  renal 
plexus;  the  umbilicus  as  a  landmark  for  the  renal  vessels  and  their  sympa- 
thetic supply  (two  inches  above.) 

The  lesions  usually  found  in  renal  diseases  are  as  follows:  {^\)  At  the 
atlas  or  upper  cervical,  affecting  the  superior  cervical  ganglion  and  the  ren- 
al center  in  the  medulla.  (2)  At  the  lOth,  nth  and  i2th  dorsal,  and  the 
1st  lumbar,  the  main  lesions  affecting  the  kidneys  directly.  (3)  From  the 
2d  lumbar  to  the  4th  sacral  for  disease  in  the  bladder  and  urethra.  (4)  In 
the  female  patient  it  may  occur  that  uterine  polapsus,  wrinkling  the  anterior 
vaginal  walls,  may  twist  and  obstruct  the  urethra.  (4)  In  the  male  patient  , 
and  enlargement  of  the  prostate  gland,  especially  of  its  middle  lobe,  is  with 


140  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

considerable  frequency  found  to  be  the  cause,  easily  overlooked,  of  stricture 
of  the  urethra. 

A  careful  analysis  of  the  lesions  in  the  twenty-seven  cases  presented 
above  brings  out  facts  representatix'e  of  this  class  of  cases  (urinary  diseases.) 
These  facts  well  illustrate  what  is  usually  found  in  such  cases.  The  lesions 
are  mostl\'  spinal,  few  being  rib  lesions;  but  three  of  the  tvvent)'-seven  men- 
tion rib  lesion.  As  a  matter  of  fact,  spinal  lesions  are  the  important  causes 
of  urinarv  troubles.  The  vast  nerve-suppl\'  of  the  kidneys  and  bladder  is 
delicately  balanced.  Most  of  the  lesions  in  renal  diseases  being  spinal, 
th<:  conclusion  is  that  spinal  derangement  of  this  nerve-supply  is  the  most 
potent  and  frecjuent  cause  of  such  disease.  The  kidneys  are,  at  bottom, 
generally  deranged  by  lesions  affecting  the  nerve-supply,  including  vaso- 
mptor,  i.  c  blood-sypply,  ^Isp. 

Of  these  lesions,  practically  all  are  low  down  in  the  spine,  including 
also  the  sacral  region.  Excepting  cervical  lesion,  but  one  of  the  above 
cases  mentioned  lesion  above  the  5th  dorsal.  (This  occurred  at  the  2d 
dorsal,  and  was  unimportant  because  of  other,  lower  lesions.)  Hut  five 
showed  lesion  above  the  lOth  dorsal,  and  while  lesions  of  some  importance 
occur  about  the  7th  and  8th  dorsal,  the  important  lesions  all  occur  lower 
down. 

Eleven  of  the  twent)'-seven  showed  lesion  about  the  lOth,  nth,  and  12th 
dorsal;  twenty  showed  lesion  below  and  including  the  loth  dorsal;  ten 
showed  lesion  below  the  i2th  dorsal,  i.  e  ,  in  the  lumbar  and  sacral  regions. 
'.These  latter  occur  chiefly  in  bladder  and  urethral  diseases.  This  is  seen  in 
the  fact  that  of  the  seven  cases  of  enuresis  reported,  six  presented  lumbar 
and  sacral  lesions.  The  fact  that  twenty  showed  lesion  below  the  loth  dor- 
sal, eleven  of  them  being  about  the  lOth,  nth  and  I2lh  dorsal,  must  be  re- 
marked in  considering  distinctively  kidney  diseases.  In  the  cases  of  Bright's 
Disease  mentioned,  all  in  which  the  lesion  was  described  showed  lesion  in 
the  lower  dorsal  and  lumbar  regions,  practically  all  of  these  concentrating 
about  the  lOth  to  12th  dorsal.  In  nine  of  these  cases  the  micturition  center 
at  the  2d  lumbar  was  affected,  participating  in  both  kidney  and  bladder  af- 
fections. Its  anatomical  relations  make  it  most  important  in  the  latter 
class,  and  experience  shows  that  it  is  more  likely  to  affect  bladder  than 
kidneys. 

Xeck  lesion  is  not  important.  Only  three  of  the  cases  showed  them, 
but  the)"  occurred  at  the  2d  to  4th  \ertebrae,  where  they  could  all  affect  the 
superior  cervical  ganglion,  and  through  it  the  n-)edulla.  This  location  of 
the  lesion  is  mainl)-  im[)ortant  as  a  secondary  or  adjuvant  lesion  in  renal 
diseases. 

Without  exception,  the  lesions  in  these  cases  fall  within  areas  in  which 
they  may  affect  the  sympathetic  inncr\-ation  of  the  urinary  apparatus.  It 
is  noticeable,  therefore,  that  only  through  this  nerve-supply  could  they 
become  the  causes  of  renal  disease,  even  though  they  should  be  mainl)-  up- 


PRACTICK  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  T4I 

on  the  blood-suppi)'.     The  \aso-motor  function  in  relation  to    disease    thus 
has  its  importance  eimphasized. 

Anatomical  Relations:  Sensory  nerves  are  distributed  through  the 
sympathetic,  from  the  spinal  nerves,  as  follows:  To  the  kidneys  from  the 
loth,  nth  and  I2th  dorsal;  to  the  upper  part  of  the  ureter,  from  the  roth 
dorsal;  at  the  lower  end  of  the  ureter  supply  from  the  1st  lumbar  tends  to 
appear;  to  the  mucous  membrane  and  neck  of  the  bladder,  from  the  (ist) 
2d,  3d  and  4th  sacral;  for  sensation  of  over-distention  and  ineffectual  contract- 
ion, from  the  nth  and  I2th  dorsal  and  ist  lumbar  (Ouain.)  This  sensory 
distribution  is  made  use  of  in  relieving  spinal  pain  in  kiduey  and  bladder- 
disease.  Disturbed  sensations  in  these  parts  is  usually  found  associated 
with  lesion  in  the  spinal  areas  named,  generally  in  connection  with  more 
serious  trouble. 

Vaso-motor  fibres  for  the  renal  vessel  are  found  in  the  splanchnics,  and 
somewhat  below,  occuring  from  the  6th  dorsal  to  the  2d  lumbar  nerve.  As 
shown  by  the  American  Text  Book  of  Physiology,  stimulation  of  the  central 
endings,  not  only  of  the  splanchnics,  but  also  of  the  sciatic,  causes  constric- 
tion of  the  renal  vessels.  Thus  work  upon  the  spine  over  the  origin  of  the 
great  sciatic  nerve,  at  the  4th  and  5th  lumbar,  and  1st,  2d  and  3d  sacral, 
is  useful  in  controlling  the  circulation  of  the  kidneys.  Actual  cases  of  kid- 
ney diseases  show  spinal  lesion  as  high  as  the  5th  or  6th  dorsal,  and  as  low 
as  the  3d  or  4th  sacral.  The  continual  action  of  lesion  in  these  situations 
upon  the  vaso-motors  of  the  kidneys  has  most  important  pathological  re- 
sults through  modification  of  the  renal  blood-supply.  As  a  rule  these  les- 
ions are  concentrated  about  the  10th  dorsal  to  2d  lumbar.  The  main  vaso- 
motor suppl)',  originating  as  above  described,  passes  from  the  aortico-renal 
ganglion,  solar  and  aortic  plexuses  to  the  renal  plexus.  Important  branches 
come  from  the  renal  splanchnics,  sometimes  also  from  the  lesser  splanchnic 
and /rom  the  first  lumbar  ganglion.  The  branches  of  this  plexus  lies  upon 
the  renal  vessels,  and  accompany  them  in  their  ramifications  in  the  kidne\'s. 
Osteopathic  work  upon  this  important  vaso-motor  supply  of  the  kidne\'s 
via  fhe  splanchnic  area  of  the  spine  (by  remo\'al  of  lesion)  and  the  renal 
plexus,  which  is  reached  by  abdominal  u'ork  at  the  level  of  the  umbilicus, 
gains  marked  results  upon  the  circulation,  and  through  it  upon  the  whole 
metabolism  of  the  kidneys. 

The  blood-vessels  and  the  muscular  coat  of  the  bladder  are  supplied 
b\'  the  vescical  plexus.  It  consists  of  numerous  nerves  from  the  lower  end 
of  the  pelvic  plexus  to  the  side  and  lower  part  of  the  bladder.  The  supply 
to  the  fundus  of  the  bladder  is  from  the  hypogastric  plexus.  The  Ameri- 
can Text  Book  points  out  that  stimulation  of  the  2nd,  3rd  and  4th  sacral 
nerves  causes  reflex  contraction  of  the  bladder.  The  chief  motor  fibres  of 
the  bladder,  probabl\'  suppl\ing  the  longitudinal  muscle  fibres,  pass  to  the 
bladder  from  the  sacral  nerx'es.  At  the  same  time  some  of  the  motor  fibres 
passing   to  the  bladder  in  the  \escical  plexus  rise  in  the  lumbar  nerves  and 


142  PRACTICE  AND  APPLrEU  TH  KRAPEUTICS  OF  OSTEOPATHY. 

reach  their  destination  via  the  aortic  plexus,  inferior  mesenteric  ganglion 
and  hypogastric  and  pelvic  plexuses.  They  supply  the  circular  muscle  fibres 
of  the  bladder  and  its  sphtncttr. 

These  facts  explain  vvh)-  lower  spinal  lesion  is  so  often  found  by  the 
Osteopath  to  be  the  cause  of  motor  derangement  of  the  bladtler.  A  good 
illustration  of  this  is  seen  in  the  lack  of  motor  control  \n  enuresis,  due  as  a 
rule  to  low  lesions.  Reference  to  the  case  reports  above  will  show  that  six 
of  the  seven  cases  of  enuresis  presented  lumbar  and  sacral  lesion. 

These  anatomical  facts  underlie  osteopathic  theor)'  of  renal  diseases. 
They  form  a  foundation  of  truth  for  osteopathic  procedure.  Lesion  to  these- 
various  important  nerve-supplies  at  their  origin  along  the  spine  must  pro- 
duce renal  disturbance  in  kind,  and  this  disturbance  can  be  righted  only  by 
correction  of  the  anatoiuical  deranrrement  responsible  for  them. 


ACUTE  NEPHRITIS.     (Acute  Frights  Disease.) 

Dei-imtion:  An  acute  intlammation  of  the  kidneys,  mild  or  severe,  at- 
tended b)'  structural  changes  iir  the  organ.. 

The  Lesfons  and  Anatomical  Relations  have  been  drsctissed.  Le.s- 
ions  occur  preferabl)-  from  the  rOth  dorsal  to  the  upper  lumbar,  but  may  be 
either  higher  or  lower.  Cervical  lesions,  as  low  as  the  jrd  or  4tb  vertebra, 
may  occur. 

The  Prognosis  is, on  the  whole,  good,  stfll  bearing  inmind  the  necessity 
of  guarded  prognosis  in  all  renal  diseases  as  above  indicated.  Considering^ 
the  seriousness  of  the  disease,  it  is  a  matter  of  rem-ark  how  many  cases  of 
Acute  Bright''s  disease  have  been  apparently  entircl)' cured.  Good  results 
are  quickly  evident  under  the  treatment.  The  ordinary  course  of  a  few 
days  to  six  weeks  is  generally  shortened. 

According  to  Anders  the  restoration  of  the  destro}'ed  eDrthelium  and 
of  the  glomerular  function  may  occur.  The  chances  of  accomplishing  the 
result  by  the  natural  method  of  restored  and  corrected  circulation  as  brought 
about  by  osteopothic  treatment  v/ould  seem  of  the  best.  The  same  author 
states  that  \n  cases  due  to  exposure  to  cold  and  wet,  irrespective  of  alcoholic 
indulgence,  it  may  be  presumed  with  reason  that  there  is  some  inherent  or 
acquired  weakness  or  a  susceptibility  of  the  kidneys  rendering  them  the 
weak  links  in  the  visceral  or  systemic  chain.  It  is  the  osteopathic  idea  tha£ 
these  cases,  as  a  rule,  present  lesions  of  the  spine  of  such  a  nature  as  to 
interfere  with  the  vital  forces  distributed  to  the  kidneys.  This,  we  reason, 
is  the  "inherent  or  acquired  weakness  or  susceptibility  of  the  kidneys  that 
renders  their  weak  links  in  the  visceral  chain,"  and  that  is  the  real  cause 
why  they  fall  victims  to  the  various  causes  ascribed  as  the  active  agents  in 
producing  the  disease.  This  explains  why  the  poison  of  acute  infectious; 
diseases,  as  in  scarlet  fever,  producing  nephritis  in    certain    cases,  has   been 


PRACTICE  AND  APPLIKD  THERAPKUTICS  OF  OSTEOPATHY.  I43 

able  to  unbalance  the  already  weakned  urinary  mechanism.  The  same  ex- 
planation holds  good  for  all  the  ordinary  active  causes  of  the  disease.  It 
seems  to  be  the  sufficient  reason  \vh\-  one  person  (presumably  with  spinal 
lesion)  suffers  from  the  disease  while  similar  circumstances  have  failed  to 
cause  it  in  another. 

Treatment:  The  general  treatment  for  nephritis,  acute  and  chronic, 
have  been  given  with  that  for  congestion  of  the  kidneys,  q.  v.,  as  stated  at 
that  place.  Its  object,  as  stated,  is  primarily  to  gain  vaso-motor  control, 
and  thus  allay  inflamation,  relieve  vascular  tension,  and,  through  restored 
and  corrected  circulation,  to  clear  away  the  debris  from  the  tubules,  absorb 
the  exudates,  check  degenerative  on  new  growths,  and  rebuild  as  far  as  pos- 
sible the  destroyed  or  compromised  renal  epithelium, 

Repeated  and  careful  analysis  of  the  urine  must  be  made  in  all  cases  of 
nephritis  for  signs  of  the  processes  in  the  kidneys  as  directed  in  standard 
medical    texts. 

In  Acute.  N^pfn-itis,  aside  from   the    main    treatment    already   discussed, 
.    the  practitioner  must  direct  his  work  to  the  alleviatian  of  many  of  the  mani- 
I J    festations  of  the  disease.     The  general    treatment    will  allay    many   of    the 
sK     symptoms  at  once;  others  may  call  for  special  attention.  Uremic  symptoms, 
.      such  as  nausea,  vomiting,  headache,  and  pain  in  the  back  are  treated  as   be- 
^y^'fore  directed.      For  the  latter,  relaxation  of  the  spinal  muscles    and    inhibi- 
I  ^     tion  01  the  sensory  nerves  (lOth  to  12th  dorsal.)  Convulsions  are  quieted  by 
VKj     inhibitive    spinal  treatment  and  by  inhibition  of  the  centers  or  local  nerve- 
^    suppl)'  for  the  affected  part.     The  dropsy  is  relieved  by  the  stimulation    of 
A    the  general  circulation  brought  about  by  the  general  treatment.     It  is  aided 
■^    by  local  treatment  of  the  venous  flow  from  the  part  affected,  e.  g.,  treatment 
of  the    long   and    short  saphenous  veins,  relaxation  of  the  tissues  about  the 
saphenous  opening,  and  raising  the  intestines  from    the    femoral   veins,    in 
edema   of  the  lower    extremities.      Suppression,  if  it  occur,  yields  at  once 
generally,  to  thorough  stimulation  of  the  kidne}'.   The  lungs  ifiust  be  stimu- 
lated against  the  occurrence  of  bronchitis  or  pneumonia.      Perspiration  mav 
be  excited  by  thorough  stimulation  of  the  spinal  system.,    heart,  and    lungs. 
It  is  a  necessary  measure  for  the  relief  of  the  system  from  the  accumulated 
poisons.     As  a  rule,  it  is  readil}'  accomplished  b\-    this    treatment.     Failino- 
of  this,  recourse  should  be  had  to  the  hot  baths,  applications,  packs,  and   the 
use  of  vapor,  as  described  in  medical  texts, 

The  A)'^/6'«6' a;i(f  rt'/d'/ of  nephritis  patients  is  a  most  important  matter. 
These  should  be  carefull)-  looked  after  according  to  directions  laid  down  in 
standard  works. 

The  patient  with  acute  nephritis  should  be  treated  once  or  twice  daih'. 
More  treatment,  or  less,  may  be  given  as  the  practitioner's  judgment  dictates. 
In  Chronic  Exudativc  Nephritis  and  Chronic   Non-Exudative  Ne- 
phritis the  practitioner  must  be  constantly  upon  his  guard.    A  fair  number 
■of  cases  of  chronic  nephritis  have  been  cured    or  greatl}-   benefited.     In  the 


^ 


144  PRACTICE   VND  APPI.IKD  Til ERAPEUTICS  OF  OSTEOPATHY. 

fomer,  \.ht progtiosis,  while  guarded,  is  fair.  The  patient  may  be  cured,  or 
be  helped  to  enjoy  a  prolonged  and  comfortable  life,  In  these  cases  the 
practitioner  may  be  thrown  off  his  guard  by  the  fact  that  the  disease  may 
have  arisen  insidiousl)-  without  having  presented  n>arked  sjmptoms. 

In  the  non-exudative  form  the  prognosis  must  be  unfavorable,  owing 
to  the  very  serious  pathologidal  changes  that  have  taken  place  in  the  organ. 
I'erhaps  much  can  be  done  for  the  cop.^fort  of  the  patient.  The  slow  pro- 
gress of  the  case  renders  thorough  treatment  useful.  The  patient  may  be 
helped  to  a  long  and  comfortable  life. 

Concerning  /es/a?is  and  ircatment,  little  need  be  added  to  what  has  al- 
reatly  been  said.  Special  manifestations  of  either  forni  may  call  for  special 
treatment.  One  must  sustain  the  entire  system,  and  be  continuall)-  upoiD 
his  guard  against  a  suddembad  turn  in  the  case,  or  intercurrent  maladies  or 
complications.  The  retinitis  ntay  call  for  some  treatment  of  the  eye  local- 
ly and  through  the  cervical  sympathetic  and  blood-supply. 

Concerning  hygiene  and  diet,  the  same  remark  applies  as  for  acute  ne- 
phritis. 

Chronic  cases  should  be  treated  daily  or  three  times*  per  week,  accord- 
ing to  the  needs  of  the  individual. 


CONGESTION  OF  THE  KIDNEYS. 

In  both  acute  or  arterial  hyperemia  and  chronic  or  ver>ous  hyperemia  a 
good  PROGNOSIS  can,  generally  speaking,  be  expected.  This  must,  however^ 
\>Q guarded \x\  ^\\  cases,  especially  in  the  chronic  venous  congestion  second- 
ary to  heart  and  lung  diseases.  As  both  of  these  conditions  of  congestion) 
of  the  kidney  are  secondary  to  other  diseases,  and  as  each  may  precede  in- 
tlammation  (acute  or  chronic)  of  the  kidney,  much  care  must  be  taken  m 
prognosis  ancrtreacment.  When  the  condition  is  secondary  the  prognosis 
must  depend  upon  that  for  the  primary  disease.  Yet,  even  though  a  favor- 
able prognosis  is  limited  by  such  circumstances,  good  results  are  generally 
gotten  upon  the  kidneys.  They  are  very  responsive  to-  treatment-  it  is 
usually  readily  effective  m  producing  fTOod  effects.  "While  keeping  in  mind 
the  difficulties  presented  by  renal  cases  as  a  class,  we  can  yet  expect  im- 
provement under  the  treatment.  Yet,  the  prognosis  for  cure  is  always  to  be 
guarded. 

The  Lesions  for  kidrrey  diseases  have  beerr  discussed  above.  In  cases 
of  congestion  specific  lesion  is  expected  in  the  vasomotor  irea,  6th  dorsaE 
to  2nd  lumbar.  In  cases  secondary  to  other  disease  the  lesion  is  that  pro- 
ducing such  disease,  though  auxiliary  lesion  to  the  kidney  is  often  present 
and  has  weakened  the  organ  preliminarily  to  its  being  thus  affected.  Though 
cold  and  exposure,  the  toxic  products  of  various  acute  diseases,  and  other 
causes  ma)*  produce  congestion  directly,  it  is  still  necessary  in    most   cases 


PRACTICE  AND  APPLl  ED 'J'HERAPEUTICS  OF  OSTEOPATHV.  I45 

to  account  for  such  agents  e.speciall)'  attacking  tlie  kidnc\'s,  to  account  for 
the  disease  settling  upon  them.  There  can  be  no  doubt  that  in  very  many 
cases  it  is  the  presence  of  spinal  lesion  which  determines  the  disease  to  the 
kidne)'s.  This  hypothesis  not  onl\'  accounts  fjr  tlie  frequency  with  which 
spinal  lesions  are  found  in  such  cases,  but  aho  explains  wh)'  one  person 
may  become  the  victim  of  Icidney  disease  while  another  under  a  similar  set 
of  circumstances  escapes.  These  general  remarks  apply  with  ec^uul  force 
to  the  subject  of  nephritis  ne.xt  considered 

The  Treatment  has  lOr  its  object  the  correction  of  the  waso-molor 
disturbance  evident  as  congestion  of  the  Icidnej's.  It  gains  vaso-motor  con- 
trol both  directly,  by  treatment  to  the  kidne\'s,  and  indirectly,  if  necessary, 
by  the  tre.itment  of  the  disease  to  which  the  congestion  is  secondar)'.  In 
the  latter  case  the  main  treatment  must  Ije  (iirccted  to  the  j^rimary  disease. 
The  spinal  lesio-  to  the  kidne\s  must  alwa\  s  be  removed. 

Treatment  to  gain  vaso-motor  control  is  made  tlirectly  upon  the  vaso- 
motor innervation  of  the  ]<idneys.  This  consists  (in  addition  to  the  re- 
moval of  the  lesion  obstructing  them)  of  spinal  stimulation  from  the  6th 
dorsal  to  the  2nd  lumbar,  for  the  vaso- motor  fibres  to  the  kidneys  originat- 
ing in  this  spinal  area.  This  includes  the  whole  splanchnic  area.  As  stimu- 
lation over  the  central  ends  of  the  splanchnics  and  of  the  great  sciatic  is 
known  to  cause  renal  constriction,  it  is  well  to  carry  this  spina!  stimulation 
down  over  the  origin  of  the  sciatic  nerve,  including  the  4th  and  5th  lumbar 
and  the  upper  three  sacral. 

This  treatment  for  the  circulation  is  aidea  b)-  direct  work  over  the  re- 
gion of  the  kidney.  Deep  pressure,  with  a  spreading  motion,  applied  at 
the  umbilicus  and  about  rwo  inches  above  it,  stimulates  tlie  peritoneal  nerve- 
centers  said  to  exist  at  each  side  of  the  umbilicus,  it  also  reaches  the  renal 
and  supra-renal  plexuses  and  aortico-renal  ganglion,  lying  upon  the  aorta 
and  renal  vessels,  the  plexus  ramifying  the  kidney  upon  thejolood-vessels. 
This  treatment  further  affects  the  renal  vessels  mechanically,  and  relieves 
it  of  tension  in  the  surrounding  tissues. 

The  spinal  treatment  should  be  applied  especially  to  the  region  of  the 
lesser  and  renal  splanchnic.  In  these  various  ways  the  kidney  circulation 
is  equalized  and  the  inflammation  or  congestion  is  reduced. 

To  aid  in  calling  the  blood  from  the  kidneys  and  in  equalizing  the 
general  body  circulation,  general  deep  inhibitive  work  is  made  over  the 
abdomen  to  call  the  blood  to  its  vessels;  a  general  spinal  and  neck  treat- 
ment, particularly  directed  to  stimulation  of  heart  and  lungs  and  to  the  in- 
hibition of  the  superior  cervical  ganglion,  tones  the  general  circulation  and 
relieves  blood-tension  (through  the  superior  cervical). 

A  valuable  spinal  treatment  for  stimulation  of  the  kidneys  is  perform- 
ed with  the  patient  lying  on  his  back.  The  practitioner's  hands  are  slipped 
palm  up  beneath  the  back,  one  on  each  side,  in  the  region  of  the  innerva- 
tion of  the  kidneys.     Now  as  the  fingers  are  bent  at  the  metacarpo-phalan- 


146  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

geal  knuckles,  making  a  fulcrum  of  the  latter  upon  the  table,  the  cushions 
of  the  finj^ers  are  pressed  deeply  into  the  spinal  tissues,  the  weight  of  the 
patient  is  raised  by  the  fingers  thus  applied,  and  the  tissues  are  drawn  later- 
ally away  from  the  spine.  Quick  repetetion  of  this  movement  a  number 
of  times  thoroughly  manipulates  the  tissues  and  stimulates  the  nerve-con- 
nections of  the  kidne\s. 

The  bowels  and  skin  should  be  kept  free  and  acti\e  by  treatment  as  be- 
fore described. 

The  treatment  thus  described  applies  not  only  to  congestion  of  the 
kidneys,  but  to  nephritis,  next  to  be  discussed. 

In  both  forms  of  congestion  of  the  kidneys  the  case  must  be  carefully 
looked  after  to  obviate  the  danger  of  its  passing  into  inflammation,  acute 
hyperemia  tending  to  acute  nephritis,  the  passive  congestion  tending  to  be- 
come chronic  nephritis. 

The  patient  should  be  kept  quiet,  resting  in  bed,  and  upon  a  liquid  diet, 
in  active  hyperemia.  In  venous  congestion  a  light  diet  must  be  followed. 
The  patient  should  drink  plenty  of  pure  water.  Hot  baths  and  hot  applica- 
tions over  the  kidneys,  may,  if  necessary,  be  used  with  advantage.  In  the 
acute  form  the  patient  should  be  seen  daily;  more  than  one  treatment  per 
diem  may  be  necessary.  In  the  venous  form  daily  treatment  should  be 
eiven. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  147 


RENAL  CALCULI. 

Definition:  Fine  or  coarse  concretions  in  the  substance  of  the  kidney 
or  in  the  renal  pelvis  resulting  from  precipitation  of  the  solid  constituents  of 
the  urine.  It  is  due  to  spinal  lesion  which  disturbs  the  normal  secretorj' 
activities  of  the  kidney  and  leads  to  the  deposition  of  certain  substances. 

The  Lesions  and  Anatomical  Relations  have  been  discussed  under  the 
general  consideration  of  renal  diseases.  Lesions  from  the  loth  dorsal  to  the 
ist  lumbar,  including  those  of  the  lower  two  ribs,  are  the  most  frequent  in  these 
cases.  No  pathognomonic  lesion  has  been  located  for  this  condition.  From 
the  nature  of  the  case,  any  lesion  interfering  with  the  proper  innervation  and 
circulation  of  the  kidney  might  so  interfere  with  normal  secretions  as  to  render 
them  disproportionate  or  excessive  as  to  certain  constituents.  Whether  the 
stone  be  of  uric  acid  or  urates,  of  calcuim  oxalate,  phosphates,  o*-  some  other 
substance,  it  is  clear  that  some  cause  is  operating  which  prevents  the  natural 
proportions  of  the  renal  constituents  from  being  msintained.  While,  as  Anders 
states,  the  causes  are  not  well  known,  the  osteopathic  view  is  that  the  real 
cause  is  found  in  spinal  lesion  which  deranges  the  vital  forces  underlying  kid- 
ney activity.  It  is  as  reasonable  that  spinal  lesion  should  unbalance  the  deli- 
cate sympathetic  nerve-mechanism  controlling  these  organs,  leading  to  dispro- 
portionate or  excessive  secretion  of  the  urinary  constituents  and  the  precipita- 
tion of  the  stone,  as  that  spinal  lesion  should  in  a  similar  way  disturb  intestinal 
secretion  and  lead  to  diarahoea. 

The  Prognosis  is  good,  both  for  the  removal  of  the  stone  and  for  the  pre- 
vention of  its  further  formation.  Immediate  relief  is  usually  given  in  the  case 
of  renal  colic,  and  the  case  is  entirely  cured  under  the  treatment.  The  treat- 
ment of  these  cases  is  uniformly  successful. 

The  Treatment  has  as  its  object  the  removal  the  stone  and  the  correction 
of  the  metabolism  of  the  kidney  to  prevent  stones  being  formed  again.  The 
stone  may  be  removed  in  one  of  two  ways.  Correction  of  the  activities  of  the 
organ  will  lead  to  disintegration  of  the  stone.  Renal  secretions  dissolve  kidney 
stones.  (A.  T.  Still.)  Stones  too  large  to  pass,  formed  by  the  precipitation 
of  insoluble  substances,  necessitate  operation.  This  corrective  work  embraces 
the  removal  of  lesion,  and  general  stimulation  of  controlling  nerves  and  circu- 
lation. This  is  accomplished  by  both  spinal  and  local  abdominal  treatment  as 
before  described  in  the  treatment  of  the  kidney.  Under  this  restorative  pro- 
cess normal  urine  is  secreted  and  the  stone  is  dis.solved. 

This  same  procedure  would  prevent  the  formation  of  more  calculi.  It 
would  be  efficient  in  all  cases,  and  should  be  administered  to  cases  passing  renal 
sand  or  gravel  without  pain  as  a  prophylactic  against  worse  conditions,  and  to 
cure  the  case.  It  corrects  those  conditions  favoring  precipitation;  lessens  the 
ascidity  of  the  urine,  dispels  the  uric  acid,  increases  the  salines,  etc. 


I4S  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

The  stone  may  also  be  removed  by  manipulation  of  it  along  the  ureter  and 
into  the  bladder.  The  practitioner  is  generally  called  to  these  cases  during  an 
attack  of  renal  colic.  Under  these  conditions  the  finst  step  is  to  allay  the  usually 
extreme  pain.  First,  spinal  inhibition  is  to  be  made.  As  the  sensory  innerva- 
tion is  through  the  sympathetic,  from  the  loth  dorsal  for  the  upper  part  of  the 
ureter,  while  at  the  lower  end  the  1st  lumbar  probably  supplies  the  structure, 
strong  inhibition  (as  in  diarrhoea)  must  be  made.  As  the  pain  spreads,  and  is 
very  likely  to  extend  down  the  spine  to  the  testacle  or  inner  side  of  the  thigh, 
it  is  well  to  carry  the  inhibitation  from  the  middle  dorsal  down  over  the  sacrum. 
After  this  treatment  obdominal  work  is  better  borne.  This  is  a  very  deep,  firm, 
but  not  rough,  treatment  over  the  course  of  the  ureters.  It  is  slow,  inhibitive 
and  relaxative,  thus  helping  to  quiet  the  pain  and  relaxing  the  ureter  for  the 
passage  of  the  stone.  This  relaxation  may  be  aided  by  inhibition  of  the  in- 
ferior mesenteric,  spermatic,  and  pelvic  (lower  hypogastric)  plexuses.  This 
treatment  aids  the  ureter  to  pass  the  stone  by  mechanically  working  along. 
It  should  be  begun  at  a  point  about  two  inches  above  and  two  inches  external- 
ly from  the  umbilicus  and  progress  diagonally  downward  and  inward  to  the 
promontory  of  the  sacrum  and  as  far  below  it  as  possible  This  treatment 
reachei:  the  ureter  by  deep  pressure  of  the  overlying  tissues  down  upon  the 
ureter.  It  must  be  very  dee]),  but  slow  and  with  the  careful  avoidance  of  any 
violence.  Usually  the  stone  is  readily  parsed  under  the  Ireatment,  but  some 
cases  require  nearly  continuous  treatmen'.  for  a  con-siderable  time,  three-quarters 
of  an  ho'jr  or  more.  If  possible,  treatment  should  not  be  stopped  until  the 
stone  is  passed.  Treatment  afterwards  over  the  sore  parts  may  be  necessary. 
The  patieni's  system  should  be  stimulated  against  syncope  or  collapse  by  treat- 
ment of  the  heart,  lungs,  and  cervical  region. 

The  ])aiient  should  be  directed  to  avoid  red  meats  and  those  articles  of 
drink  and  diet  favoring  uric  acid.  He  should  lead  a  temperate  life,  taking 
moderate  exercise.  The  drinking  of  lemonade,  soda-water,  and  plenty  of  pure 
water  is  a  valuable  aid  and  in  keeping  the  kiJneys  flushed  and  free. 

PvKLiTis,  if  present,  must  be  treated  (aside  from  the  removal  of  the  stone 
from  the  pelvi^)  as  the  inflammatory  conditions  of  the  kidney  before  di.scussed. 

Movable  Kidney  (Nephroptosis,  Dislocated  Kidney,)  may  be  successful- 
ly treated  by  osteopathic  means  if  it  has  not  that  extreme  degree  of  mobility 
known  as  "floating  kidney."  Movable  kidney  is  the  term  designating  ihe  con- 
dition in  which  the  upper  end  of  the  organ  may  be  pushed  down  to  the  level  of 
the  umbilicus.  The  /csio?is,  so  far  as  this  condition  may  be  traced  to  them,  are 
of  the  sort  producing  enteroptosis,  q.  v.  There  is  usually  present  a  slight 
curvature  ofthe  dorsj-lumbirspine  (McCjnnell).  A  bid  spiaal  condition,  or  a 
definite  single  lesion,  compromises  blood  and  nerve-supply  of  the  organ  and 
its  related  tissues,  weakens  the  tissues  and  vessels  supporting  it  in  place,  and 
allows  of  a  prolapsus  of  the  organ  directly  or  by  allowing  other  causes  to  oper- 
ate. Thus  it  occurs  as  a  part  of  enteroptosis,  or  from  falls,  heavy  lifting,  strain- 
ing at  stool,  etc.     Spinal  lesions  causing  relaxed  abdominal  walls,  also  repeat- 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I49 

ed  pregnaucies  producing  the  same  result,  favor  mobility  of  the  kidney.  Lesions 
and  diseases  leading  to  extreme  emaciation  and  consequent  wasting  of  the 
fatty  tissues  of  the  capsule  of  the  kidney  may  cause  this  condition,  as  may  also 
tight  lacing. 

.Treatment:  From  the  nature  of  these  causes  it  may  be  seen  that  one's 
chances  of  curing  a  moderate  degree  of  movable  kidney  are  good,  the  causes 
being  removable.  Much  the  same  treatment  would  be  given  as  for  enteroptosis. 
The  removal  of  spinal  lesion,  spinal  treatment  to  restore  tone  to  the  support- 
ing tissues,  local  treatment  at  the  kidney  to  mechanically  replace  it  and  to  re- 
move the  tenderness  and  swelling  in  it  due  to  twisting  of  the  renal  vessels,  and 
abdominal  treatment  to  restore  tone  in  the  surrounding  and  supporting  tissues 
would  all  be  useful.  In  cases  suffering  from  extreme  emaciation  attention 
should  be  given  to  the  general  health  and  to  incrersing  the  nutrition  of  the 
body.  Abdominal  supporters  and  pads  should  be  gradually  laid  aside,  the 
abdominal  muscles  being  toned  to  act  in  their  stead.  The  neurasthenia  and 
general  nervous  symptoms,  indigestion,  palpitation,  irritable  bladder,  etc.,  call 
for  general  treatment  of  the  nervous  system  coupled  with  special  treatment 
for  any  particular  troublesome  manifestation. 

The  patient  should  have  plenty  of  rest  lying  down,  and  should  avoid  over- 
exertion, overeating,  ^training  at  stool,  etc. 


CYSTITIS. 

Definition:  An  acute  or  chronic  inflammation  of  the  mucous  membrane 
of  the  bladder. 

Lesions  and  Anatomical  Relations:  Lumbar  and  sacral  lesions  pre- 
dominate in  bladder  troubles.  The  urino-genital  center  occurs  in  the  spine 
from  the  2nd  to  5th  lumbar,  while  the  sensory  nerve-supply  to  the  mucous 
membrane  and  neck,  of  the  bladder,  is  derived  from  the  (ist)  2nd,  3rd  and  4th 
sacral.  The  vescical  plexus  is  derived  from  the  lower  end  of  the  pelvic  plexus 
and  supplies  vaso-motor  fibres  to  the  blood-vessels  of  the  bladder.  Through 
the  pelvic  plexus  it  is  in  connection  with  both  lumbar  sympathetic  and  sacral 
nerves,  hence  may  be  subject  to  the  effect  of  lumbar  or  sacral  lesion,  acting  to 
derange  the  blood-supply  of  the  bladder.  Such  lesion  weakens  this  circulation 
and  renders  the  bladder  liable  to  the  action  of  various  causes  to  produce  the 
cystitis.  In  this  way  cold  or  exposure  could  cause  the  condition.  Through 
lesion  to  the  motor  nerves  of  the  bladder  (see  Enuresis)  a  paresis  of  the  bladder 
walls  may  be  caused,  leading  to  cystitis.  An  enlarged  prostate  may  cause 
pressure  upon  the  bladder  and  retention  of  urine,  leading  to  the  disease. 
Traumatism,  such  as  the  careless  use  of  catheter  or  sound,  irritation  of  fecal 
matter  or,  of  a  stone  in  the  bladder,  or  from  a  pregnant  uterus,  may  be  a  suf- 
ficient cause.     This  is  also  true  of  septic  causes  of  cystitis;  the  introduction  of 


150  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

an  unclean  catheter,  the  poisonous  products  of  febrile  diseases,  of  gonorrhoea, 
etc.,  becoming  direct  causes  of  the  condition.  Yet  in  many  of  such  cases  the 
weakness  of  parts  due  to  spinal  lesfon  precedes  and  predisposes  to  the  trouble. 
Also  lesion  is  often  the  direct  cause  of  the  condition  leading  to  cystitis,  as  in 
inflammation  of  the  surrounding  organs;  vaginitis,  urethritis,  etc. 

The  Treatment  is  to  restore  normal  circulation.  It  is  upon  that  part  of 
the  spine  pointed  out  above  as  related  directly  to  the  vaso-motor  innervation 
of  the  bladder.  Lesion  in  these  areas  must  be  removed.  Such  treatment  is 
often  followed  by  great  relief  at  once.  Local  abdominal  treatment  over  the 
course  of  the  internal  iliac  venis  aids  in  reducing  the  inflammation.  The  ab- 
dominal treatment  must  be  carefully  applied.  It  may  be  made  over  the  hypo- 
gastric plexus  to  aid  in  controlling  the  circulation.  It  should  be  inhibitive. 
Inhibitive  and  relaxing  treatment  aids  in  quieting  the  pain  and  vescical  irri- 
tability. It  also  calls  the  blood  to  the  abdominal  vessels,  away  from  the  bladd- 
er. An  enlarged  prostate  must  be  reduced,  (Chap.  IX.  D)  and  mechanical 
irritants  must  be  removed  if  possible. 

For  the  pain  and  irritation  of  the  bladder,  strong  inhibition  should  be 
made  from  the  ist  lumbar  down,  especially  over  che  2nd,  3rd  and  4th  sacral 
nerves.  For  the  vescical  and  rectal  tenesmus,  stimulation  of  the  lumbar,  and 
especially  of  the  sacral  region  should  be  made  after  the  pain  is  allayed. 

The  patient  should  remain  lying  down,  as  it  is  said  that  then  the  intra- 
vescical  pressure  is  but  one-third  as  great  as  in  the  erect  position.  The  diet 
should  be  simple,  avoiding  highly  seasoned  foods  and  alcohol.  In  the  early 
stages  a  milk  diet  is  recommended.  The  patient  should  drink  freely  of  water 
for  internal  irrigation  of  the  bladder.  Treatment  should  be  given  to  keep 
active  the  cutaneous  circulation  (2nd  dorsal,  5th  lumbar,  superior  cervical). 
This  is  aided  by  general  spinal  treatment,  by  friction  of  the  skin,  and  by  bath- 
ing. The  bowels  must  be  kept  open  and  the  kidneys  free.  The  usual  treat- 
ments should  be  given  for  this  purpose.  Hot  sitz  baths  aLd  hot  applications 
may  be  employed  to  relieve  the  pain  in  the  intervals  between  treatments,  if 
necessary. 

The  patient  should  be  treated  once  or  twice  daily. 

In  the  chronic  case  the  prognosis  is  fair,  but  guarded.  Treatment  should 
proceed  along  the  lines  laid  down  above.  In  this  form,  and  in  septic  cystitis, 
washing  out  the  bladder  is  a  valuable  aid  to  the  treatment.  For  the  chronic 
case  boiled  water,  sterile  normal  salt  solution  (4060  gr.  to  a  pint),  or  a  weak 
solution  of  mercuric  cblorid  (i:  50,000  or  100,000 )  are  recommended.  For 
septic  cases,  a  Saturated  solution  of  boric  acid  may  be  used. 


ENURESIS,  (Incontinence  of  Urine). 

Definition:  Inability  to  retain  the  urine,  A  neurosis  due  to  sacral  or 
lumbar  lesion  which  so  affects  the  motor  nerve  mechanism  of  the  bladder  as  to 
result  in  lack  of  control. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  151 

Lesions  and  Anatomical  Relations:  The  lesions  usually  occur  in  the 
lower  lumbar  and  sacral  regions.  They  have  been  discussed  in  the  beginning 
of  the  chapter  on  renal  diseases  (see  ante).  Frequently  some  single  lesion,  as 
of  the  2nd  or  5th  lumbar,  is  found,  the  removal  of  which  cures  the  case  at 
once.  A  common  lesion  is  weakness  and  posterior  position  of  the  whole  lum- 
bar spine.     Quite  often  lower  dorsal  lesion  is  found. 

As  the  vescical  plexus  supplies  the  muscular  coats  of  the  bladder,  and  as 
it  is  in  connection,  through  the  pelvic  plexuses,  with  both  the  lumbar  and 
sacral  nerves,  lesions  of  these  portions  of  the  spine  may  readily  affect  the 
motor  activities  of  the  bladder.  This  becomes  more  evident  in  the  light  of  the 
fact  that  the  motor  fibres  of  the  circular  muscles  and  sphincter  of  the  bladder 
are  derived  from  the  lumbar  portion  of  the  sympathetic,  by  way  of  the  aortic 
plexus,  the  inferior  mesenteric  ganglion,  the  hypogastric  and  pelvic  plexuses. 
On  the  other  hand,  the  sacral  nerves  furnish  the  chief  motor  supply  to  the 
longitudinal  muscle  fibres  of  the  bladder.  (Qnain.)  The  American  Text  Book 
of  Physiology  states  that  stimulation  of  the  sacral  nerves  (ist,  2nd,  3rd  and 
4th)  causes  a  reflex  contraction  of  the  bladder.  It  is  evident  that  lumbar  and 
spinal  lesion  may  directly  affect  this  nerve-supply.  The  lesion  involving  the 
sphincteric  center  of  the  bladder;  the  paralytic  incontinence;  the  imperfect 
vescical  innervation  and  paresis  of  the  walls  from  over  distention;  the  spas- 
modic incontinence  due  to  over  action  of  the  compressor  muscle  of  the  bladder, 
may  all  arise  from  spinal  lesion  as  described  occuring  at  certain  or  various 
points  in  the  lumbar  and  sacral  regions.  This  lesion  ma}'  cause  a  stoppage  of 
nerve-supply,  resulting  in  a  paralytic  condition,  or  an  irritation  of  the  bladder. 
The  anatomical  relation  between  lesion  and  disease  is  clear  in  this  case. 

The  Prognosis  is  good.  Very  many  cases  have  been  successfully  treated. 
Generally  quick  results  are  attained.  In  some  cases  a  few  treatments  cause 
immediate  lessening  of  the  trouble. 

Treatment:  The  relation  of  lesion  to  disease  is  .so  close  in  this  disease 
that  the  first  step  is  to  remove  the  lesion.  This  may  be  all  the  treatment 
necessary.  A  thorough  stimulation  of  the  lumbar  and  ^acral  region  affects 
the  nerve-connections  explained  above  and  tones  the  n  otor  mechanism  of  the 
bladder.  Spasmodic  conditions  call  for  thorough  inhibition  of  thee  regions. 
Corrective  spinal  work  restores  normal  conditions  and  allows  Nature  to  attend 
to  the  result.  Abdominal  treatment  over  the  hj'pogastric  plexus  and  over  the 
internal  iliac  vessels  aids  the  case.  When  the  condition  is  due  to  a  postrating 
disease  the  treatment  must  be  directed  as  well  to  the  upbuilding  of  the  system. 
A  prolapsed  uterus  must  be  replaced,  and  other  irritating  causes  removed. 
Among  the  latter  may  be  intestional  worms,  an  elongated  prepuce,  etc  Cir- 
cumcision is  advisable  in  the  latter  case.  In  neurotic  children  treatment  must 
be  given  to  the  general  nervous  system. 

Note:  —  A  case  of  kidney  trouble  is  reported  in  which  insuflSciency  of  urine 
was  overcome  solely  by  stimulation  of  the  superior  cervical  ganglion.  A  renal 
center  exists  in  the  medulla.     The  treatment  trebeled  the  amount  of  the  urine. 


152  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

No  Other  treatment  was  given.  Probably  the  general  systemic  vaso-constric- 
tion  set  up  by  stimulation  of  the  general  vaso-motor  center  in  the  medulla, 
through  the  treatment  of  the  superior  cervical  ganglion,  supplied  tte  increased 
blood-pressure  and  arterial  tension  in  the  kidneys  necessary,  under  the  circum- 
stances, to  the  activity  of  the  organ. 


DISEASES  OF    THE  HEART'  AND  CIRCULATORY  SYSTEM. 

As  in  considering  the  disease  of  the  urinary  system,  a  number  of  cases  are 
here  noted  for  their  value  in  showing  various  facts  in  regard  to  the  practice 
upon  cases  of  this  cla.ss.  They  show  either  important  lesion,  the  removal  of 
which  cured  the  disease;  quickness  of  results  gained  by  osteopathic  treatment 
in  serious  or  long  standing  cases,  unrelieved  by  other  methods  of  treatment; 
and  something  of  the  variety  and  range  of  the  practice  in  these  cases.  These 
reports,  as  far  as  they  go,  are  typical  of  the  practice.  They  are  not,  however, 
presented  as  model  case  reports,  nor  as  representing  the  whole  field  of  prac- 
tice in  diseases  of  this  class. 

Cases:  (i)  Impeded  heart-action,  resulting  from  a  fall  caTising  spinal 
injury  and  nervous  shock.     The  marked  lesion  was  found  at  the  atlas. 

(2)  Fatty  degeneration  of  the  heart.  The  patient  was  too  weak  to  walk; 
the  action  of  the  heart  was  very  weak;  arrhythmia  was  present;  great  dropsy 
of  the  lower  limbs  prevailed.  The  patient  could  sleep  only  by  kneeling  over  a 
couch  with  the  chest  supported  by  pillows.  This  position  relieved  irritation 
from  the  lesion.  Lesion  was  marked;  there  was  great  contracture  of  the  mus- 
cles from  the  atlas  to  the  6th  dorsal,  especially  marked  in  the  upper  dorsal 
region.  The  patient  was  very  round-shouldered.  These  causes  caused  a 
drawing  together  of  the  sternal  ends  of  the  ribs,  and  lessened  the  cavity  of  the 
chest,  allowing  of  less  room  for  the  heart's  action.  For  two  weeks  the  patient 
was  treated  daily,  and  could  then  lie  down  to  sleep.  After  one  month  he  could 
walk  a  quarter  of  a  mile  to  the  oflBce  for  treatment  and  return  unaided.  At 
the  end  of  a  three  month  course  of  treatment  he  returned  home  to  work,  and 
was  well  two  years  later. 

(3)  A  case  of  extreme  palpitation  was  relieved  in  fifteen  minutes. 

(4)  Great  palpitation  of  the  heart,  due  to  marked  spinal  curvature  in  the 
upper  dorsal  and  cervical  regions,  came  upon  the  patient  frequently.  Such 
an  attack  was  usually  treated  medically  with  digitalis  and  kept  the  patient  in 
bed  for  several  days.  Osteopathic  treatment  always  relieved  the  patient  of 
such  an  attack  in  a  few  minutes  and  the  patient  could  go  about  her  usual 
duties.  It  was  a  common  occurence  in  this  case  to  slow  the  heart-beat  as  much 
as  twenty  beats  per  minute,  this  effect  not  being  transient,  but  lasting  for  sev- 
eral days. 

1^5)     Arrhythmia  and  a  general  bad  condition  of  the  health;  lesion    of   the 


PRACTICK  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I53 

4th  left  rib;  slight  lateral  lesion  of  the  fifth  lumbar  vertebra.  The  latter  was 
probably  responsible  for  uterine  trouble  present,  which  may  have  influenced 
the  heart.     After  two  months'  treatment  the  heart-beat  was  almost  normal. 

(6)  Palpitation;  a  smothering  sensation  had  occurred  for  many  years 
when  the  patient  lay  down.  This  was  accompanied  by  pain  in  the  heart.  The 
case  so  improved  in  three  weeks  under  treatment  that  the  patient  could  with 
impunity  drink  coffee  and  smoke  tobacco,  whereas  these  articles  had  been 
quite  interdicted  to  him  by  his  previous  condition. 

(7)  A  case  variously  diagnosed  as  valvular  lesion,  hypertrophy,  angina, 
pectoris,  etc.,  was  cured  in  one  month  by  osteopathic  methods. 

(8)  Marked  arrhythmia,  with  nervousness  and  insomnia,  was  so  bene- 
fitted in  four  treatments  that  the  heart  action  became  normal.  WithDut 
further  treatment  its  normal  action  still  continued  two  months  later. 

(9)  Arrhythmia,  in  which  the  patjent  was  very  weak.  The  left  5th  rib 
was  down  upon  the  6th  and  slightly  inward.  The  cervical  and  upper  thoracic 
spinal  muscles  were  very  much  contracted.  The  treatment  was  directed  to 
raising  the  riband  relaxing  the  contractured  muscles,  and  resulted  in  regulat- 
ing the  heart-beat  in  six  weeks. 

(10)  A  case  of  chronic  endocarditis,  given  up  by  medical  practice,  was 
cured  in  six  weeks  under  osteopathic  treatment. 

(ri)  Bad  palpitation,  of  several  years'  standing,  was  cured  in  three 
months. 

(12)  Palpitation  and  a  complication  of  diseases;  lesion  found  at  the  atlas 
and  in  the  upper  dorsal  spine.  No  palpitation  occurred  after  the  third  treat- 
ment. 

(13)  A  case  of  valvular  weakness  reported  cured  in  three  months. 

(14)  Enlargement  of  tlie  heart,  mitral  and  aortic  incompetence,  and  re- 
gurgitation showed  lesion  in  forward  displacement  of  the  ajLias,  lesion  of  the 
left  clavicle  and  upper  tivo  or  three  left  ribs.  Three  trnatments produced  much 
improvement,  one  months  treatment  corrected  the  arrhythmia,  and  constant 
improvement  went  on  under  treatment. 

(15)  A  case  of  palpitation  of  the  heart,  with  goitre,  uterine  disease,  etc., 
presented  contracture  of  the  spinal  muscles.  The  clavicles  were  both  down 
and  backward  at  the  sternal  end;  there  was  lesion  of  the  ist  right  rib  and  of 
the  2d  left  rib;  also  a  general  dropping  of  the  ribs  which  narrowed  the  chest 
cavity.  Lesion  affected  the  1st  and  2d  lumbar,  and  the  pelvis  was  tilted.  In 
six  months  all  lesions  were  corrected,  and  the  case  showed  marked  improve- 
ment. 

(16)  Palpitation  of  one  years'  standing,  attending  a  physical  or  mental 
exertion.  Sub  luxation  of  the  fiTth^rib  was  discovered.  It  was  removed  in 
one  treatment,  and  the  patient  suffered  no  further  trouble. 

(17)  Angina  pectoris  after  lagrippe;  spinal  muscles  contractured;  the  3d 
to5tb  ribs  displaced  downward.    The  case  was  cured  in  one  month. 

(18)  Angina  pectoris  showing  lesion  of  the  2d  to  5th   left  ribs.     The  left 


154  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

arm  could  not  be  raised  above  the  head  without  extreme  paiu.  Under  treat- 
ment the  pains  became  gradually  less  severe,  until  they  had  practically  ceased 
at  the  end  of  two  months. 

(19)  Pericarditis  cured  by  correction  of  rib  lesions. 

(20)  Angina  pectoris,  caused  by 'downward  displacement  of  the  left 
clavicle,  and  cured  by  its  correction. 

(21)  Functional  weakness;  sinking  spells  occurred  upon  any  exertion, 
as  in  climbing  stains.  The  left  thorax  was  found  depres.sed;  the  left  clavicle 
■was  displaced  downward  at  its  sternal  end,  while  it  was  up  and  for^^ard  at  its 
acromial  end.  All  the  ribs  were  crovi'ded  together-  Relief  followed  the  first 
treatment,  and  the  case  was  cured  in  five  weeks. 

■(22)  Cardiac  dilatation.  In  one  treatment  the  pulse  was  reduced  from 
140  to  no,  and  at  the  end  of  one  month  it  was  80.  Fainting  spells,  frequent 
before,  did  not  occur  after  the  first  treatment. 

(23)  Varicose  veins  and  milk  leg  of  fifteen  years  standing.  The  tissues 
surrounding  Hunter's  canal  and  the  saphenous  opening  were  tense,  and  the 
lumbar  vertebrae  were  anterior.  An  operation  had  been  advised,  but  the  case 
had  been  practically  cured  under  osteopathic  treatment  at  the  time  of  the  re- 
port. 

(24)  \'aricose  veins  of  eight  years'  standing.  Three  varicose  ulcers 
were  discharging;  when  treatment  began.  Innominate  lesion  was  discovered. 
The  case  was  cured  in  five  weeks. 

(25)  Varicose  veins,  for  which  operation  had  been  made  without  suc- 
cess. The  patient  was  compelled  to  sit  with  the  limb  elevated,  and  had  been 
thus  for  five  months.  The  physicians  found  they  could  do  nothing  more,  and 
recommended  continued  elevation.  One  month  of  osteopathic  treatment  cured 
the  case. 

(26  )  Weakness  of  the  heart  of  three  years'  standing.  The  i)atient  was 
unable  to  climb  stairs,  and  had  to  be  assisted  to  the  office  for  the  fiist  treat* 
ment.  The  usual  treatment,  raisins^  the  ribs,  gave  immediate  relief.  The  pa- 
tient came  alone  for  the  second  treatment,  and  was  cured  in  two  weeks. 

(  27)  Varicose  veins  of  two  years'  standing.  Severe  and  continuous  pain 
in  the  limb  prevented  sleep.  The  muscles  over  the  sacrum  and  the  lower 
lumbar  vertebrae  were  rigid.  In  one  month  of  treatment  the  case  showed 
great  improvement. 

(28)  Disturbed  circulation,  in  which  the  superficial  capillaries  of  one 
side  of  the  i>ody  were  flushed,  reddening  the  skin,  while  the  other  half  of  the 
body  was  pale.  The  line  of  demarkation  between  the  halves  of  the  body  was 
very  prominent.  This  trouble  had  come  upon  the  patient  as  the  direct  result 
of  a  hard  bicycle  ride-  Lesion  was  found  at  the  fifth  lumbar,  and  its  correc- 
cured  the  case. 

(29)  Disturbed  circulation.  The  patient  had  accidentally  received  a  hard 
blow  upon  the  head,  and  intense  pain  developed  upon  one  side  of  the  head. 
She  was  unable  to  turn  her  head  without  turning  the  whole  body.     If  she  lay 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I5J 

upon  the  injured  side  great  pain  followed.  This  condition  was  of  five  years* 
standing.  Examination  showed  a  strong  contraction  of  the  deep  muscles  of 
the  neck,  which  set  up  irritation  of  the  local  sympathetic,  affecting  the  vaso- 
constrictor fibres  of  the  side  of  the  head  in  question,  causing  over-contraction 
of  the  vessels,  setting  up  the  pain.  Treatment  was  directed  entirely  to  the 
contractured    muscles  and    in  fiv'e  weeks'  lime  overcame  the  trouble  entirely. 

IvESiONs:  In  seeking  the  lesion  and  in  giving  the  treatment  in  cardiac 
diseases,  certain  centers,  prominently  connected  with  the  normal,  activities  and 
pathological  manifestations  of  the  heart,  must  be  specially  examined  for  lesion. 
These  centers,  given  below,  do  not  always  relate  to  specific  anatomical  or  phys- 
iological centers  of  the  texts,  but  in  some  cases  refer  to  bony  points  become 
prominent  in  osteopathic  work  as  locations  of  lesion  or  of  places  where  treat- 
ment produces  special  results.  These  are:  the  first  rib  (heart  flutter);  cor- 
pora striata;  1st,  2d,  3d,  4th,  5th  dorsal  vertebrae;  2d  to  4th  dorsal  (valves  of 
the  heart);  3d  and  4th  cervical  (rhythm  of  the  heart);  superior  cervical  gang- 
lion (a  sympathetic  center);  upper  four  or  five  dorsal  nerves,  especially  the 
2d  and  3d  (accelerator  center);  medulla  (general  circulatory.) 

General  vaso-motor  centers  which,  with  the  special  vaso-motor  innerva- 
tion of  a  given  viscus;  suffer  from  lesion  in  circulatory  disturbances;  superior 
cervical  ganglion;  2d  dorsal,  5th  lumbar,  for  general  superficial  capillary  circu- 
lation. 

The  lesions  usually  present  in  cardiac  disease  are:  (i)  of  the  atlas  and 
axis;  (2)  the  cervical  region  generally,  both  muscular  and  bony  lesion.  Les- 
ions ot  the  atlas,  axis  and  cervical  region  affect  the  superior  cervical  gang- 
lion and  the  other  sympathetic  supply  of  the  heart.  (3)  Lesions  of  the  clav- 
icle are  found,  as  are  those,  (4)  of  the  1st  rib,  (5)  of  the  2d  rib,  (6)  of  the 
upper  six  ribs,  especially  on  the  left  side,  (7)  of  the  upper  five  dorsal  verte- 
brae, (8)  as  a  change  in  the  general  shape  of  the  thorax,  (9)  of  the  fifth  left 
rib  in  particular.  (10)  of  the  diaphragm,  i.  e.,  of  the  lower  six  ribs,  any  or  all 
of  them,  and  of  certain  portions  of  the  spine,  (p.  96  ) 

Lesions  were  reported  in  twenty  of  the  above  twenty-nine  ctses.  This 
number  of  case  reports  is  too  meagre  to  be  used  as  the  basis  of  conclusive 
proof  as  to  lesions  in  the  disease,  yet  an  analysis  of  the  cases  presents  facts 
typical  of  those  pertaining  to  general  practice  in  this  line.  From  this  stand- 
point they  are  instructive. 

Five  of  these  twenty  cases  reporting  lesion  were  not  cardiac  disease.  In 
thirteen  of  the  fifteen  cardiac  cases  reporting  lesion,  rib  lesion  was  present. 
These  lesions  are  of  prime  importance  in  such  diseases.  They  seem  to  be  rel- 
atively more  frequent  than  other  sorts,  perhaps  for  the  reason  that  they  affect 
the  heart  often  mechanically,  through  alteration  of  the  chest  cavity,  as  well  as  by 
interference  with  its  nerve  connections.  A  s  to  kind,  the  rib  lesion  is  as  import- 
ant as  any  other  lesion,  while  as  to  frequency  it  is  of  greater  importance.  Eight 
of  the  thirteen  rib  lesions  were  of  the  4th  and  5th  ribs,  either  or  both,  and  usu- 
ally of  the  left  side.     As  a  matter  of  fact  lesions  of  these  two  are  the  most    im- 


1  56  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

portant  of  the  rib  lesions.  They  may  affect  both  nerve-counections  and  me- 
chanical relations  of  the  heart.  The  fact  that  the  apex  beat  (falling  at  the 
fifth  interspace)  may  be  interfered  with,  easily  deranging  the  whole  delicate 
rhythm  of  the  organ,  may  account  in  part  for  the  frequency  with  which  such 
lesion  causes  cardiac  disease.  In  six  of  the  thirteen  the  ist  and  2d  rib  pre- 
sented lesion,  usually  on  the  left  side.  While  these  lesions  are  not  so  generally 
the  cause  of  heart  disease,  they  are  frequent  and  important  lesions  in  these 
cases.  Their  main  effect  is  through  disturbance  of  the  nerve  connections.  The 
first  rib  may  derange  circulation  through  the  sub-clavian  vessels,  as  may  the 
clavicle.  In  four  of  the  fifteen  cases  lesion  of  the  clavicle  occurred.  While 
not  frequent,  these  lesions  may  be  the  cause  of  serious  trouble. 

Spinal  lesions,  including  both  muscular  and  bony,  are  of  the  greatest  im- 
portance when  it  is  considered  that  rib  lesion  contributes  to  them  by  distubance 
of  the  spinal  nerve-connections.  They  occur  in  seven  of  the  above  fifteen 
cases.  They 'act  by  producing  derangement  of  the  important  nerve-connec- 
tions in  the  upper  dorsal  region.  From  this  point  of  view  bony  and  muscular 
lesions  in  the  cervical  region  become  significant,  while  not  so  frequently  the 
sole  cau.se  of  heart  disease,  they  yet  often  occur  and  derange  the  important 
sympathetic  nerve  connections  of  the  heart  and  this  region.  Lesions  of  the 
atlas,  axis,  or  of  any  of  the  first  three  or  four  cervical  vertebral,  also  of  the 
rectus  capitis  anticus  major  muscle,  may  affect  the  superior  cervical  ganglion 
as  well  as  other  cervical  sympathetics  In  si.K  of  the  fifteen  cas^s  cervical  lesion 
occurred,  three  of  the  six  being  ^ielooation  of  the  athas. 

It  may  be  noted  that  practically  all  of  the  above  lesions  affect  the  heart, 
in  whole  or  in  part,  through  its  nerve-connections.  This  seems  to  be  the  most 
important  avenue  over  which  abnormal  influences  travel  from  lesion  to  heart. 
B}'  working  directly  upon  nerve  distribution  to  the  heart,  irrespective  of  lesion, 
important  changes  are  readily  made  in  its  activities.  Physiologically  this 
organ  is  markedly  affected  by  nervous  influences.  It  seems  that  a  viscus 
whose  nervous  equilibrium  is  so  readily  disturbed  or  influenced,  should  be 
peculiarly  susceptible  to  the  influence  of  lesions  to  its  regulative  mechanism. 
Such  lesions  as  osteopathy  considers,  affecting  this  mechanism  directly  as  it 
does,  must  be  the  true  cause  of  many  pathological  states.  Their  removal  is 
therefore  a  rational  means  of  cure. 

The  diaphragmmatic  lesion  is  of  some  importance  in  heart  diseases,  as 
mentioned  above.  In  four  of  the  fifteen  cases  such  lesion  was  rjresent  as  may 
have  affected  the  diaphragm. 

In  the  cases  of  varicose  veins  reported  the  importance  of  lumbar,  sacral 
and  innominate  lesion  becomes  apparent,  also  of  the  stoppage  of  venous  re- 
turn. The  two  cases  of  vascular  disturbance  showed  lesion  of  the  cervical  re- 
gion and  of  the  5th  lumbar  vertebra,  it  being  noticable  that  each  came  at  a 
place  at  which  it  could  effect  the  center  for  superficial  circulation,  (Superior 
cervical  and  .5th  lumbar.) 

In  seventeen  of  the  twenty  cases  benefit  or  cure  was  made  in  a  short  time, 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV.  I  5/ 

considering  the  case.  In  periods  varying  from  one  or  a  few  treatments  to  three 
months  results  were  attained  in  long  standing  or  serious  cases  that  well  dem- 
onstrated the  superiority  of  osteopathic  therapeutics.  In  one  case  the  pulse 
was  reduced  from  140  to  no  at  the  first  treBtment,  and  was  kept  down  and 
constantly  improved  thereafter.  In  case  4  it  is  pointed  out  that  the  pulse  could 
be  slowed  as  much  as  twenty  beats  per  minute.  Considering  the  fact  that  a 
cardiac  medicine  that  reduces  the  heart  beat  one  per  minute  is  a  successful 
one,  it  is  readily  seen  that  osteopathic  control  of  the  heart  is  most   successful. 

The  Anatomical  Relations  between  the  lesion  and  the  heart-disease 
are  made  clear  by  the  following  facts  :  In  view  of  them  it  seems  that  the  sci- 
ence of  Osteopathy,  by  its  methods  of  diagnosis,  arrives  at  the  real  cause  of 
the  disease.     This  is  true  also  with  reference  to  diseases  in  general. 

The  pneumogastric  nerves  and  the  sympathetics  are  the  cardiac  nerves. 
The  pneumogastric  is  the  heart  inhibitor,  and  its  center  has  been  definitely 
located  in  the  medulla.  It  is  a  well-known  osteopathic  fact  that  lesion  in  the 
superior  cervical  region,  acting  through  the  superior  cervical  ganglion,  may 
disturb  the  centers  contained  in  the  medulla.  In  such  case  the  heart  may  be 
affected  by  disturbance  of  the  center  of  cardiac  inhibition. 

Special  details  of  the  action  of  the  vagus  in  inhibiting  the  heart  have 
been  observed.  Strong  stimulation  of  the  nerve  lengthens  both  systole  and 
diastole,  i.  e.  slows  the  beat.  It  also  lessens  the  force  of  contraction,  and 
causes  the  heart  to  beat  not  only  more  slowly,  but  more  weakly.  At  the  same 
time  this  stimulation  results  in  the  heart  handling  less  blood,  as  the  output 
and  the  input  of  the  ventricle  are  both  diminished.  The  ventricular  tonus  is 
diminished,  and  the  heart  dilates  furher  by  vagus  stimulation,  while  at  the 
same  time  the  walls  of  the  ventricle  have  been  found  to  be  softer. 

Osteopathic  lesion  to  the  vagi  is  a  demonstrated  fact.  In  view  of  the 
above  functions  of  these  nerves,  it  becomes  at  once  apparent  that  lesion  to 
them  might  cause  serious  disturbance.  An  irritative  lesion,  keeping  up  stim- 
ulation of  the  nerve,  would  permanently  slow  the  beat,  lessen  cardiac  force, 
retard  circulation,  and  possibly  lead  to  dilated  and  flaccid  heart.  On  the  other 
hand,  should  the  lesion  be  of  a  nature  to  cut  off  or  to  inhibit  to  a  degree  the 
vagal  impulse  normally  retarding  the  heart  within  limits,  the  accelerator  sym- 
pathetics would  be  left  free  to  run  the  heart  too  fast.  In  either  case  the  re- 
moval of  the  lesion  to  the  pneumogastric  would  be  of  prime  importance  in 
curing  the  condition.  Aside  from  removal  of  lesion,  osteopathic  treatment  of 
the  vagi  has  been  demonstrated  to  influence  heart  action.  The  after  effect  of 
vagus  stimulation  Gaskell  notes  to  be  increased  force  of  cardiac  contraction. 
This  is>an  indication  that  upon  removal  of  lesion  Nature  would  make  special 
effort  to  repair  the  former  deficiency  of  function.  As  it  is  known  that  section 
of  the  vagus  is  followed  by  atrophy  of  the  cardiac  muscle,  it  would  be  possible 
that  serious  lesion  might  approximate  such  a  result. 

The  vagus  supplies  the  heart  by  its  upper  and  lower  cervical  and  thoracic 
cardiac  branches,  which    join    with    the    sympathetic  and    go  to    the  cardiac 


158  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

plexus.  It  also  has  connection  with  the  superior  cervical  ganglion.  As  this 
nerve  is  known  to  be  amenable  to  osteopathic  treatment  at  many  points,  like- 
wise susceptible  of  lesion  at  various  places,  as  at  the  at^as,  axis,  and  upper 
dorsal  via  its  sympathetic  connections,  along  the  sterno-mastoid  muscle  and  at 
the  clavicle,  its  importance  in  relation  to  the  cause  and  cure  of  heart  disease 
is  apparent. 

The  cardiac  depressor  nerve,  whose  presence  has  been  demonstrated  in 
man,  as  well  as  in  various  other  mammals,  retards  heart  action  in  a  manner 
diflerent  from  that  of  the  vagus.  Its  stimulative  impulses  come  from  the 
heart  and  act  upon  its  sympathetic  connections  with  the  splanchnics  to  pro- 
duce a  reflex  vaso-dilatation  in  the  abdominal  vessels.  They  dilate  and  receive 
a  large  amount  of  blood  from  the  general  system,  the  general  blood  pressure  is 
lessened,  arterial  tension  falls,  and  the  heart  is  thus  quieted. 

An  important  avenue  to  the  heart  is  through  •  the  cervical  sympathetic 
ganglia,  each  of  which  sends  a  cardiac  branch  to  the  cardiac  plexus.  Between 
these  branches,  the  branches  of  the  vagus,  and  the  thoracic  sympathetic,  there 
are  numerous  points  of  communication.  Each  ganglion  is  so  situated  and  so 
connected  with  the  spinal  nerves  that  it  is  susceptible  to  lesion.  The  upper 
ganglion  lies  in  front  of  the  second  and  third  cervical  vertebrae  and  communi- 
cates with  the  upper  four  cervical  nerves.  It  may  suffer  from  lesion  of  the 
upper  three  vertebrae.  Its  branches  of  communication  with  the  third  and  4th 
cervical  nerves  of  ten  pierce  the  rectus  capitis  auticus  major  muscle,  on  the 
sheath  of  which  the  ganglion  lies.  Contracture  of  this  muscle  may  act  as 
lesion  to  them.  The  middle  ganglion  lies  in  front  of  6th  and  7th  cervical  ver- 
tebrae and  connects  with  the  5th  and  6th  cervical  nerves.  The  lower  gang- 
lion lies  in  front  of  the  ist  costo-vertebral  articulation,  and  connects  with  the 
7th  and  8th  cervical  nerves.  They  are  susceptible  to  lesion  respectively  of  the 
5th  and  6th  cervical  vertebrae  and  of  the  7th  cervical  vertebrae  and  the  6rst  rib. 
All  three  are  liable  to  muscular  lesion.  Hence  the  importance  of  neck  lesion 
in  cardiac  disease. 

The  accelerator  or  augmentor  nerves  of  the  heart  are  sympathetic-  They 
are  antagonistic  to  the  vagi.  That  they  are  likely  to  suffer  from  spinal  lesion 
is  at  once  apparent  from  their  anatomical  relations.  They  are  derived  from 
the  upper  four  or  five  dorsal  nerves,  especially  from  the  2nd  and  3rd.  They 
join  the  sympathetic  at  the  middle  and  lower  cervical,  perhaps  also  first 
thoracic,  ganglia.  (Quain)  The  most  important  treatments  for  cardiac  stimu- 
lation or  inhibition  are  made  in  the  upper  dorsal  region,  at  ihe  origins  of  these 
nerves,  by  stimulation  or  inhibition  of  them.  Important  heart  lesions  occur 
in  the  upper  dorsal  region  (spine  or  rib)  and  ptobably  affect  the  heart  through 
these  conections.  The  connection  of  these  glanglia  with  the  middle  and  in- 
ferior cervical  ganglia  lends  the  latter  added  importance  in  these  matters. 

When  these  accelerators  are  stimulated  they  increase  ihe  frequency  of 
the  heart-beat  from  7  to  70  per  cent,  but  a  long  stimulation  produces  no  greater 
acceleration  than  a  short  one.     This  marked  increase  in  the    pulse    is  quickly 


PRACTICE  AND  APPLIKD  THERAPEUTICS  OF  OSTEOPATHY.  I  59 

apparent  under  osteopathic  stimulation  of  the  accelerators.  Further  results 
of  stimulating  them  are  an  increased  force  of  the  ventricular  beat,  the  ventri- 
cles are  more  completely  fi'led  by  the  auricles  and  thei^  volume  is  increased. 
The  strength  and  volume  of  the  auricular  contractions  are  also  increased. 
Hence  our  treatment  both  quickens  and  invigorates  the  heat  muscle. 

Lesions  of  the  lower  cervical,  upper  dorsal,  or  upper  thoracic  (rib)  region 
might  be  of  such  a  nature  as  to  maintain  continual  stimulation  of  the  accelera- 
tors, lead  to  permanently  quickened  and  strengthened  heart-beat,  and  produce 
such  an  affect  as  hypertrophy  of  the  heart.  Or  the  lesion  might  cut  ofif  or 
lessen  the  accelerator  impulse,  leading  to  abnormally  slow  heart-beat,  lack  of 
strength  of  heart  action,  etc.  Hence  the  importance  of  correcting  lesion  in 
these  regions. 

Jacobson  (in  Hilton's  "Rest  and  Pain")  points  out  that  the  cardiac  plexus, 
through  the  aortic  plexus,  is  connected  with  the  4th,  5th,  and  6th  spinal  nerves. 
This  fact  may  in  part  explain  the  importance  of  lesion  of  the  4th  and  5th  ribs 
in  heart  disease.  The  ist,  2nd  and  3rd  spinal  nerves,  through  the  sympathetic, 
supply  sensory  fibers  to  the  heart.  (Quain)  The  above  facts  explain  why 
secondary  lesion  as  contractured  muscles  may  occur  along  the  upper  dorsal 
spine  as  far  as  the  6th  in  cardiac  disease. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  163 


ANATOMICAL  RELATIONS.     Continued. 

The  cardiac  plexus  is  made  up  of  the  cardiac  branches  of  the  vagus 
and  from  the  cervical  ganglia,  whose  functions  and  relations  to  cardiac 
disease  were  pointed  out  above.  This  plexus  suffers  from  lesion  of  those 
nerves,  and  is  the  medium  through  which  such  lesion  acts  upon  the  heart. 
The  right  and  left  coronarj'  plexuses  derived  from  the  cardiac,  supply  the 
coronary  arteries.  Lesion  to  them,  through  the  cardiac,  would  influence 
nutrition  and  circulation  in  the  heart  substance. 

The  intercostal  nerves  may  become  important  paths  of  transmission  of 
the  effects  of  lesion  to  the  heart.  It  is  well  known  that  rib  lesions  are 
among  the  most  frequent  causes  of  heart-disease.  Possibl)-  much  of  their 
influence  is  by  irritation  to  the  intercostal  nerves.  These  nerves  are  the 
anterior  primary  branches  of  the  spinal  nerves,  and  the  ramus  communicans 
from  each  thoracic  sympathetic  ganglion  passes  directly  to  the  intercostal, 
nerve  corresponding.  As  shown  above,  the  heart  is  in  connection  with  the 
upper  six  dorsal  nerves  through  its  sympathetic  supply.  The  upper  four 
or  five  give  origin  to  the  accelerators.  The  ist,  2nd,  and  3rd  contribute 
sensory  branches  to  the  heart.  The  4th,  5th,  and  6th  connect  with  the 
cardiac  plexus  through  the  aortic.  Hence,  on  account  of  this  direct  con- 
nection between  heart  and  the  anterior  primary  divisions  of  the  upper  six 
dorsal  nerves  the  immediate  effect  of  lesion  in  this  portion  of  the  thorax 
might  be  upon  the  heart.  Hence  the  importance  of  luxateil  ribs,  sore 
and  contractured  intercostal  muscles,  a  narrowed  chest  and  changed  shape 
of  the  thorax.  These  facts  emphasize  the  importance  of  the  maintainence 
of  free  thoracic  play  in  the  maintainence  of  the  health  of  the  thoracic 
\iscera. 

A  general  changed  shape  of  the  thorax  ma)'  have  its  bearing  upon  the 
etiology  of  cardiac  trouble  in  other  ways.  The  total  intercostal  circulation 
represents  a  considerable  portion  of  the  general  circulation.  If  this  whole 
circulation  be  obstructed,  as  may  occur  in  those  conditions  in  which  a  gen- 
eral alteration  in  the  shape  of  the  thorax  has  produced  narrowing  of  the 
intercostal  spaces,  the  heart  must  be  put  to  greater  exertion  to  force  the 
blood  through  this  area  of  obstructed  vessels.  Furthermore,  such  a  con- 
dition of  narrowed  thorax  is  just  the  one  pointed  out  as  the  cause  of  lesion 
to  the  diaphragm  which  obstructs  the  flow  of  blood  through  the  aorta  and 
still  further  embarrases  the  heart,  Take  these  obstructions  to  intercostal 
and  aortic  circulation  in  conjunction  with  rib  lesions  to  intercostal  nerves^ 
a  frequent  occurance.  and  it  could  hardly  result  otherwise  than  that  cardiac 
derangement  must  follow. 

The  phrenic  nerve  innervates  both  heart  and  diaphragm.  Lesion  to  it 
may  affect  this  organ,  or  treatment  of  it  may  aid  in  cardiac  cases.  It  is 
joined  by  branches   from  the  middle  or  lower  cervical  sympathetic   ganglia 


164  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

and  from  the  ihoracic  sympathetic,  both  of  which  are  connected  with  the 
heart  innervation.  It  perforates  the  diaphragm  and  joins  the  abdominal 
sympathetic.  It  supplies  the  right  pericardium,  the  right  auricle,  and  the 
inferior  vena  cava.  Perhaps  it,  a  motor  nerve,  coordinates  the  activities  of 
of  heart  and  diaphragm,  so  closely  related  in  function.  Its  inhibition  is 
our  common    method  of  relaxing  the  diaphragm  in   hiccough. 

Its  inhibition  would  be  important  in  securing  a  lax  or  quiet  diaphragm» 
so  desirable  in  the  treatment  of  certain  forms  of  cardiac  diseases,  the  more 
so  as  it  ma\'  likely  be  suffering  from  the  irritation  of  the  disease  affecting 
the  heart  or  its  coverings. 

Clavicular  lesion  ma\'  affect  the  subclavian  vessels,  dam  back  the  flow 
of  blootl  through  the  artery,  or  b)  preventing  the  return  flow  through  the 
vein  cause  the  pciodic  loss  of  a  heart-beat  through  insufificient  filling  of 
the  organ. 

The  intimate  relations  between  the  cardiac  nerves  and  the  general  ner- 
vous s\stem  is  seen  in  the  fact  that  stimulation  of  the  sciatic  increases  the 
force  ai?d  freciuenc)'  of  the  heart-beat,  while  stimulation  of  the  abdominal 
s\mpathetics  inhibits  heart-action.  These  facts  are  of  \alue  in  treatment 
for  the  general  circulation. 


PERICARDITIS. 

Under  osteopethic  treatment  ihepro^>ios/s  iov  cure  is  good  in  the  dry  or 
plastic  form  and  in  that  with  serous  effusion.  In  the  purulent  form,  and  in 
chronic  adhesive  pericarditis  the  prognosis  must  be  unfavorable,  though 
much  might  be  done  to  benefit  the  patient's  condition. 

The  Lesions  affect  the  blood-supply  b)'  derangement  of  the  spinal 
s)mpathetics.  Irritative  nb  lesions,  bringing  pressure  directly  upon  the 
heart,  cause  the  disease  by  mechanical  irritation  of  the  pericardium.  This 
is  especially  likel)-  to  occur  in  lesion  to  the  fourth  and  fifth  left  ribs,  they 
occuring  at  the  site  of  apex  beat  where  the  greater  range  of  motion  is  more 
likely  to  be  interfered  with  by  narrowing  of  the  thoracic  cavit)-  or  by  in- 
ward displacement  of  tliese  ribs.  Lesions  to  the  subclavian  vein  at  the  first 
rib  or  clavicle,  and  to  the  anterior  intercostal  vessels,  preventing  venous 
drainage  of  the  pericardium,  may  predispose  to  the  condition.  A  natrowed 
thoracic  cavity  and  a  deranged  diaphragm  may,  by  pressure  or  traction  up- 
on the  pericardium,  allow  special  causes  to  set  up  irritation  and  inflamma- 
tion in  the  structure.  These  various  1  .-sions  may  la\-  the  foundation  for  the 
disease,  some  special  acti\e  acause  producing  it  directlw  Thus  spinal  and 
other  lesion  to  the  cardiac  nerves  weakens  the  tissues  and  lajs  them  liable 
to  the  effect  of  such  diseases  as  rheumatism,  gout,  scarlatina,  influenza, 
etc.,  secondaril)'  to  which  pericarditis  occurs.  In  such  cases  also  attention 
must  be  given  'o  the  lesion  accountable  for  the  primar\-    disease. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  165 

In  the  TREATMENT  the  patient  must  be  kept  at  rest  in  the  recumbens  posi- 
tion to  aid  in  slowing  the  beat  of  the  heart.  This  object  is  directly  accom- 
plished by  stimulation  of  the  vagi  and  inhibition  of  the  accelerators.  The 
former  is  treated  by  manipulation  along  its  course  behind  the  sterno-mastoid 
mnscle.  Inhibition  of  the  accelerators  is  applied  along  the  spine  from  the 
6th  cervical  to  the  5th  dorsal.  With  the  patient  lying  upon  his  back  the 
left  arm  is  raised  and  held  well  above  and  behind  the  head,  while  steady 
pressure  is  applied  along  the  upper  dorsal  region  as  far  down  as  the  fifth 
vertebra. 

The  lesion  must  be  removed.  The  ribs  may  be  carefully  raised  to  free 
the  venous  circulation  through  the  internal  mammary  veins,  which  drain 
the  anterior  intercostal  veins.  This  aids  in  allaying  the  inflammation,  as 
does  all  the]  inhibitive  abdominal  treatment  by  drawing  the  blood  to  the 
abdomen.  The  latter  operation  is  assisted  by  inhibition  along  the  splan- 
chnics  at  the  spine.  Calling  the  blood  to  the  abdomen  not  only  aids  in 
allaying  the  inflammation,  but  may  very  likely  slow  the  heart  by  decreas- 
ing arterial  tension.  As  this  reflex  dilatation  of  the  abdominal  veins  is  a 
result  the  same  as  that  produced  by  the  heart  depressor  nerve  in  function- 
ing to  quiet  the  heart,  it  is  supposable  that  treatment  given  to  dilate  these 
vessels  produces  a  result  similar  to  that  resulting  from  depressor  nerve 
action. 

As  all  the  ribs  are  carefully  raised  to  expand  the  thorax  and  give  free- 
dom to  the  heart,  the  various  intercostal  muscles  should  be  gently  mani- 
fested and  relaxed.  On  account  of  the  close  connection  pointed  out  above 
between  the  intercostal  ner\'es  and  the  sympathetics  connected  with  the 
heart,  it  is  probable  that  reflex  sensations  are  transmitted  from  the  diseased 
cardiac  apparatus  to  the  intercostal  nerves,  leading  to  a  contractured  con- 
dition of  the  intercostal  muscles  generally. 

The  phrenic  nerves  should  be  inhibited  to  relax  the  diaphragm,  (and 
pericardium  (?)  which  it  supplies.)  This  treatment  is  the  more  important 
in  pericarditis,  as  the  diaphragm  is  probably  irritated  by  the  inflammation  in 
the  pericardium  directly  contiguous  to  it.  Irritation  would  mean  contrac- 
ture. This  relaxation  of  the  diaphragm  would  aid  in  quieting  the  heart 
and  in  relieving  the  whole  local  condition.  The  desirabilit)-  of  securing  a 
lax  state  of  diaphragm  and  pericardium  in  the  treatment  of  pericarditis  is 
suggested  b}-   Hilton. 

The  pain  about  the  heart  is  lessened  by  the  whole  treatment.  Direct 
treatment  may  be  made  for  it  by  inhibition  of  the  ist,  2nd,  and  3rd  dorsal 
nerves  (sensory  to  the  heart),  and  the  4th,  5th,  and  6sh  dorsal  nerves,  which 
apparently  convey  sensory  impressions  from  the  heart. 

The  dyspnea  is  relieved  by  the  allaying  of  the  inflammation,  quieting  the 
heart,  and  raising  of  all  the  ribs.  Effusion  is  prevented  or  resorbed  by 
keeping  up  free  circulation,  especially  after  the  acute  stage  for  the  latter 
object.      If  necessary,  the  ice-bag  may  be  applied  to  the  precordial    region 


l66  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

to  allay  the  inflammation.  Its  use  may  become  necessary  in  the  intervals 
between  treatment.  The  diet  should  be  of  milk  and  broths  during  the  acute 
stage.     Later  it  should  be  light. 

Treatment  should  be  given  dail\'.      More  than  one   treatment/^;-  diem 
may  be  necessary,  especially   attention  to  various  phases. 


PALPITATION. 

Definition:  A  paroxysmal  rapidit)-  of  heart-action,  perceptible  to 
the  patient,  and  usually  accompanied  by  increased  force,  disturbed  rhythm, 
precordial  distress,  anxiety,  and  dyspnea.  This  condition  is  caused  by 
special  lesion,  usually  a  bon\-  one,  that  interferes  with  the  nerve-mechanism 
or  with  the  heart  mechanically.  This,  and  the  so-called  neuroses  of  the 
heart,  are,  from  the  osteopathic  standpoint,  neuroses  mainly  because  of 
their  being  caused  by  disturbed  nerve-mechanism  of  the  organ.  This  is  no 
more  nor  less  true  in  such  diseases  than  in  the  general  diseases  of  the  heart. 

Lesions  and  Anatomical  Relations  have  been  discussed  in  a  general 
way  above.  An  examination  of  the  several  cases  of  palpitation  reported  at 
the  beginning  of  the  chapter  shows  a  wide  range  of  lesion,  namely  from  the 
atlas  to  the  last  rib,  when  considering  as  a  lesion  producing  this  condition 
these  changes  in  the  shape  of  the  thorax  and  those  lesions  of  the  lower  six 
ribs  responsible  for  lesion  of  the  diaphragm  embarrasing  the  heaj-t.  These 
lesions  may  act  by  disturbing  the  nerve-connections  of  the  heart,  by  occlud- 
ing certain  vascular  areas  or  single  vessels,  or  by  direct  mechanical  pressure 
upon  the  heart.  Lesions  of  the  clavicle  and  first  rib  are  frequent,  and  they 
by  damming  back  the  blood  in  the  sub-clavian  artery,  may  cause  periods  of 
labored  beat  of  the  heart  to  force  it  through.  Or  by  lessening  venous  flow 
from  the  sub-clavian  vein  such  lesion  may  cause  a  paroxysm  of  rapid  beat- 
ing of  the  heart  in  the  endeavor  to  fill  itself.  Cervical  and  upper  dorsal 
lesions,  curvatures  of  the  upper  spine,  lesions  of  the  upper  five  ribs,  and 
general  contracture  of  the  spinal  muscles  could  all  act  as  irritants  upon  the 
accelerator  sympatbetics  noted  as  rising  from  the  upper  four  or  fi\e  dorsal 
nerves  and  passing  to  the  middle  and  lower  cervical  sympathetic  ganglia. 
Stimulation  of  these  accelerators  thus  caused  could  produce  the  rapid  beat- 
ing of  the  heart  found  in  palpitation.  This  class  of  lesion  i^-  most  frequent 
in  these  cases. 

Atlas  lesion  may  affect  the  heart  through  the  superior  cervical  ganglion 
and  its  upper  cardiac  branch.  But  through  this  ganglion  such  lesion  is  able 
to  affect  the  inhibitory  center  in  the  medulla,  or  it  may'affect  the  vagus  it- 
self by  way  of  its  sympathetic  connections  with  the  ganglion  mentioned. 
The  result  is  over-activity  of  the  inhibitor  function  of  the  vagus  and  the 
rapid  beat  thus  allowed  as  the  result  of  unapposed  activity  of  the  accelera- 
tor.    This  style  of  lesion  is  not  a  frequent  cause  of  palpitation. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHS.  167 

It  may  be  argued  that  as  bony  lesions  are  by  nature  continuous,  the 
paroxysmal  rapidit)-  of  the  heart  in  palpitation  could  not  be  thus  ciused, 
that  the  effect  of  this  continuous  lesion  must  itself  be  continuous  as  oppos- 
ed to  paroxysmal.  Such  is  not  the  case,  however.  The  lesion  may  not  be 
so  excessive  in  degree  as  to  keep  up  continual  irritation.  Its  irritation  may 
become  active  only  in  certain  motions  or  postures  of  the  affected  parts.  It 
may  be  th:?neuropathic  bass  weakening  the  nerve  tissues  and  leaving  the  heart 
liable  to  the  effects  of  special  emotions,  stimulants,  etc.  The  lesion  might 
t.\cn  per  se  be  of  a  nature  to  cause  continuous  irritation  and  yet  its  effects 
not  be  continually  apparent  as  rapid  heart-beat  on  account  of  the  natural 
variation  in  the  activity  of  the  accelerator  centers  and  in  the  condition  of 
the  nervous  S}'stem. 

Luxation  of  the  fifth  left  rib  mechanically  irritates  the  heart  and  causes 
palpitation.  Occuring  as  it  does  at  the  site  of  the  apex-beat,  it  is  just  as 
likel}'  a  cause  of  palpitation  as  is  the  pressure  from  a  stomach  dilated  with 
gas.  Displacement  of  this  rib  and  of  the  4th  is  a  common  cause  of  palpita- 
tion. Rib  lesions  in  general  are  quite  apt  to  be  found  in  cases  in  which  pal- 
pitation is  brought  on  by  slight  muscular  exertion.  The  movable  rib,  be- 
ing luxated,  is  readily  thrown  into  an  exaggerated  condition  of  lesion  upon 
muscular  effort.  Cases  are  continuall\'  met  in  which  some  special  form  of 
muscular  activity,  perhaps  necessitated  b)-  the  patient's  occupation,  has  first 
caused  the  displacement  and  has  then  bcome  the  repeatedly-acting  cause 
of  the  various  attacks  of  palpitation  which  have  folio  ved. 

A  frequent  and  serious  cause  of  heart  disease  in  general,  as  well  as  of 
palpitation  in  particular,  is  found  in  a  general  downward  luxation  01  the 
ribs  resulting  in  a  narrowed  thorax.  Such  a  condition  becomes  a  three-fold 
lesion.  Looked  at  as  the  cause  of  palpitation  it  acts:  (1)  By  partially  oc- 
cluding the  calibre  of  the  arteries  in  the  total  intercostal  area,  aggregating 
a  considerable  vascular  total.  (2)  By  causing  lesion  to  the  diaphragm  of  a 
nature  allowing  it  to  constrict  the  aorta.  As  a  result  of  all  this  arterial  ob- 
struction the  heart  labors  (palpitation)  to  force  the  blood  along  its  accustom- 
ed channels.  (3)  B\' irritation  to  the  intercostal  nerves  in  the  narrowed  in- 
tercostal spaces.  The  upper  six  of  these  nerves,  as  above  explained,  are  in 
direct  sympathetic  connection  with  the  heart  and  convey  to  it  the  irritation 
engendered  in  the  intercostal  spaces,  causing  it  to  palpitate. 

It  will  be  noted  that  chronic  heart  sufferers  are  very  often  the  posses- 
sors of  flat  chests  and  narrowed  thora.xes. 

Dyspepsia,  flatulence  and  diseased  abdominal  organs  often  reflcxly  set 
up  palpitation.  It  may  be  that  both  effects  are  the  results  of  a  common  le- 
sion, i.  e.,  one  to  the  splanchnic  nerves  (abdominall)'  or  spinall)')-  It  has 
been  explained  that  the  depressor  nerve  of  the  heart  acts  reflexly  through 
the  splanchnics  to  produce  vaso-dilatation  in  the  great  abdominal  vascular 
area, "bleeding  the  patient  into  his  own  veins,"  and  cause  a  fall  of  blood-pres- 
sure   with    a    quieting    of  the  heart.     On  the  other  hand,  splanchnic  lesion 


l68  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

may  set  up  intense  vaso-constriction  in  this  area,  oppose  the  circulation  of 
the  blood  in  this  way,  and  cause  the  labored  beat  or  palpitation  of  the  heart 
to  force  the  blood  through. 

The  common  cause  assigned  for  palpitation,  such  as  a  strong  emotion, 
the  use  of  tea,  coffee,  tobacco,  and  alcohol;  reflex  disturbances  from  the 
ovaries,  uterus,  and  other  pelvic  organs,  etc.,  seem  to  be  but  incidental. 
There  must  be  some  cause  determining  the  effects  of  these  agents  upon  the 
heart.  Otherwise  it  is  hard  to  explain  why  these  things  effect  one  patient's 
heart  and  not  that  of  another.  The  real  cause  weakening  the  heart  and  al- 
lowing these  incidental  causes  to  disturb  it  lies  in  the  anatomical  weak  point 
affecting  the  organ  or  its  connections.  A  multitude  of  cases  cured  by  re- 
placement of  a  displaced  rib,  or  the  like,  leads  to  the  conclusion  that  these 
so-called  causes  had  little  to  do  with  the  real  cause;  cf  case  6  above,  in  which 
three  week's  treatment  cured  palpitation  of  many  year's  standing,  and 
rendered  the  patient  immune  to  the  effects  of  coffee  and  tobacco,  which  be- 
fore he  could  not  use. 

In  cases  where  the  palpitation  is  purel)'  secondary,  as  in  anemia,  from 
the  changed  state  of  the  blood,  and  in  acute  infections  diseases,  from  the 
irritation  of  toxic  substances  circulating  in  the  blood,  the  lesions  belong  to 
the  primar)'  disease. 

The  Prognosis  is  good.  The  most  marked  and  long  standing  cases 
have  yielded  readily  to  treatment.  The  case  is  generally  relieved  at  once 
and  soon  cured. 

The  Treatment  at  the  time  of  attack  must  look  at  once  to  quieting  the 
the  nerve  irritation  that  is  causing  the  trouble,  (i)  Often  the  immediate 
removal  of  the  lesion  is  practicable  and  is  the  sole  treatment  necessary. 

(2)  Inhibition  of  the  accelerators  in  the  manner  described  in  detail  in 
the  previous  pages  is  the  most  efficient  method  of  at  once  relieving  the  pal- 
pitation. Considerable  pressure  may  be  applied  to  the  accelerator  area  of 
the  spine,  the  left  arm  meanwhile  being  strongly  held  above  the  head  (see 
Pericarditis).  Steady  pressure  at  each  point  along  these  nerves  for  several 
minutes  is  necessary.  During  this  treatment  one  hand  is  slipped  beneath  the 
patient,  the  arm  may  be  held  down  above  the  head  against  the  table  by  the 
pressure  of  the  practitioner's  trunk  against  it,  while  with  his  free  hand 
relaxes  the  intercostal  tissues  all  about  the  precordial  region.  This  is  to 
release  contractions  in  the  intercostal  muscles  set  up  by  the  irritation  carri- 
ed from  the  cardiac  plexus  to  the  upper  intercostal  nerves,  with  which  it  is 
closely  connected. 

(3)  Stimulation  of  the  pneumogastric  nerves  in  the  neck  aids  in  inhibit 
the  heart  action  (IV,  Chap.  IV). 

(4)  Stimulalion  of  the  abdominal  sj'mpathetics,  by  a  quick  treatment, 
will  aid  in  inhibiting  the  heart  bert.  A  better  method,  however,  is  to  dilate 
the  vast  abdominal  vascular  system  by  the  deep,  inhibitive  abdominal  treat- 
ment.    This    drains  the  blood  into  the  abdomen,  decreases  general  arterial 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  169 

tension,  and  quiets  the  heart.  It  is  the  exact  orocess  b}'  which  the  depressor 
nerve  quiets  the  heart,  and  may  possibly  cause  it  to  function,  Strong  in- 
hibition of  the  spinal  splanchnics  aids  this  process. 

(5)  All  the  ribs  should  be  carefully  elevated  to  allow  free  play  to  re- 
spiration and  heart.  The  dyspnea  is  a  reflex  from  the  disturbed  heart.  It 
is  relieved  by  this  treatment,  and  by  the  relieving  of  the  heart. 

(6)  Other  sources  of  irritation,  as  anemia,  pelvic  disease,  etc.,  call  for 
special  treatment. 

(7)  Upon  the  attack  the  patient  should  be  laid  upon  his  back  at  once, 
and  the  clothing  about  the  chest  and  neck  should  be  loosened.  Treatment 
(2)  should  be  at  once  applied.  In  case  of  necessity  during  the  practitioner's 
absence  an  ice-bag  applied  to  the  precordial  region  is  a  good  domestic  rem- 
edy. The  patient  may  swallow  bits  of  ice  or  drink  plentifully  of  cold 
water.     Hot  and  somewhat  stimulating  drinks  are  recommended. 

If  the  attacks  are  frequent  or  persistent  the  treatment  must  be  often 
given.  In  treatment  to  prevent  the  recurrence  of  attacks  a  course  of  treat- 
ment may  be  carried  out  aiong  the  lines  laid  down.  Special  attention  would 
naturally  be  given  the  lesion.  Heart  action  and  circulation  would  be  built 
np,  etc. 


TACHYCARDIA,  BRACHYCARDIAANDARRHYTHMIA. 

The  first  is  a  rapid  beating  of  the  heart  in  paroxysms  of  variable 
duration,  unaccompanied  by  any  marked  subjective  sensations.  The  sec- 
ond is  an  abnormal  slowness  of  the  heart,  temporary  or  permanent.  The 
third  is  irregular  beating  of  the  heart,  the  irregularity  being  manifest  in 
volume  and  force  only,  in  time  only,  or  in  both  in  various  combinations, 
presenting  various  peculiarities. 

The  lesion  and  its  mode  of  causing  disease  described  for  palpitation 
are  essentially  the  same  for  these  three  manifestations  of  disturbance  to 
the  cardiac  mechanism.  The  treatment,  also,  would  proceed  along  the 
same  general  lines  there  laid  down,  being  varied  to  suit  the  requirements  of 
the  disease  and  of  the  individual  case.  As  a  matter  of  fact  the  lesions 
found  as  the  actual  causes  of  these  different  diseases  are  practically  the 
same  in  kind,  affect  the  same  areas,  nerve  connections,  and  vascular  rela- 
tions, but  differ  in  degree,  in  concentration  upon  a  particular  region,  e.  g., 
chiefly  upon  the  accelerators  in  the  upper  dorsal  region  to  produce  tachy- 
cardia, and  therefore  in  the  particular  manifestation  or  results  of  their  pres- 
ence. 

It  is  natural  that  these  lesions  producing  palpitation  should  be  greater 
in  degree  and  more  continuous  and  severe  in  action,  thus  producing  tachy- 
cardia; that  upper  dorsal  lesion  should  so  excessively  affect  the  accelerators 
as  to  permanently  inhibit  their   activity   to  a  degree  great  enough  to    cause 


i;0  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

• 

brachycardia,  or  that  the  periodic  or  irregular  manifestations  of  such  lesion 
should  produce  arrhythmia.  The  latter  is  generally  a  feature  of  ordinary 
palpitation.  In  the  same  way  arterial,  venous,  or  other  nerve  lesion  might 
become  the  cause  of  either  disease.  In  other  words,  a  purely  osteopathic 
classification  of  diseases  would  regard  these  conditions  as  essentially  the 
same,  both  as  to  lesion  and  as  to  general  manner  of  treatment. 

The  fact  that  tachycardia  is  looked  upon  as  being  a  manifestation  of 
paral\sis  of  the  pneumogastric  or  stimulation  of  the  s}-mpathetic  is  signifi- 
cant from  the  osteopathic  view  point. 

The />/v^;/(?jv.y  for  these  conditions  is  ordinaril)-  good.  The  results  at- 
tained are  ver}'  satisfactory  and  cases  are  often  readily  cured.  The  fact 
that  they  are  frequently  symptomatic  of  other  disease,  or  secondary  thereto, 
makes  the  prognosis  and  treatment  depend  upon  the  primary  condition. 
When,  as  is  often  the  case,  they  are  found  to  depend  upon  specific  remov- 
able lesion  the  prognosis  is  good.  It  is  not  good  when  organic  heart  dis- 
ease is  present. 

The  treatment  for  these  conditions  must  be  primarily  the  removal  of 
lesion  or  irritating  cause,  or  the  treatment  of  the  primary  disease  to  which 
either  ma\'  be  secondary  or  symptomatic.  That  for  tachycardia  and  arrhy- 
thmia is  practically  that  for  palpitation.  The  treatment  for  brachycardia 
is  mainly  stimulation  of  the  accelerators.  In  the  treatment  of  brachycardia 
or  the  tachycardia  following  acute  infectious  disease,  e.  g.,  typhoid  fever, 
the  excretory  organs  must  be  stimulated  to  free  the  system  of  poison,  and 
the  centers  controlling  the  activities  of  the  heart  must  be  built  up,  as  they 
have  been  invaded  by  the  poison  of  the  disease.  In  brachjxardia  the  heart 
and  lungs  must  be  kept  stimulated  against  the  occurrence  of  syncope  or 
physical  prostration.  Treatment  in  the  intervals  ma)'  be  directed  to  up- 
building the  general  health,  mechanical  correction  of  the  body,  etc. 


ANGINA  PECTORIS. 

Definition:  Paroxisms  of  \iolent  pain  in  the  pecordial  region,  ex- 
tending to  the  neck,  back  and  arms,  and  accompanied  b>'  a  sense  of  impend- 
ing death.     It  is  said  to  be  largel)'  symptomatic. 

The  lesions  piesented  in  the  above  cases  were  main!)'  to  the  left  ribs 
over  the  heart.  One  case  showed  lesion  to  the  left  clavicle,  affecting  the 
subclavian  circulation.  Another  case  is  reported  with  the  lesion  as  a  spread- 
ing of  the  sixth  and  seventh  left  ribs  anteriorly.  Lesions  to  the  ribs  over 
the  heart  are  very  common  in  this  disease.  The  upper  dorsal  spine  is  often 
affected.  The  nature  of  the  pain  of  angina  pectoris  is  not  well  understood. 
Upper  dorsal  lesion  ma)-  irritate  the  sensory  nerves  of  the  heart,  (ist,  2d, 
and  3d  dorsal.)  The  irritation  of  the  lesion  upon  the  heart  may  result  in  a 
neurosis  of   the  sensory  branches    of  the  vagi.     Other  lesion    to    the    vagi 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I71 

through  their  sympathetic  connections  may  cause  it.  Some  writers  ad- 
vance the  theory  that  an  aortitis  is  present  and  causes  it.  A  deranged 
nerve-mechanism  as  the  result  of  spinal,  rib  and  other  lesion,  seems  suffi- 
cient, from  an  osteopathic  point  of  view,  to  cause  this  disturbance.  The 
fact  that  it  is  usually  associated  with  some  form  of  organic  heart  lesion,  ar- 
terio-sclerosis,  etc.,  is  not  contrary  to  the  idea  that  bony  lesion  is  at  bottom 
the  cause  of  the  whole  bad  condition. 

The.  prognosis  must  be  guarded  because  of  the  frequent  presence  of  or- 
ganic heart  disease  m  cases  manifesting  angina  pectoris.  The  prognosis 
for  relief  is  good,  and  cases  are  often  entirely  cured. 

The  treatment  consists  mainly  in  relieving  the  pain.  This  may  be  best 
accomplished  by  raising  the  left  lower  ribs  in  the  region  of  the  heart,  es- 
pecially incase  of  lesion  here,  by  adopting  the  motion  described  for  inhi- 
bition of  the  accelerators,  bringing  pressure  over  the  upper  three  spinal 
nerves  (cardiac  sensor)-)  at  the  same  time,  and  also  relaxing  the  tissues  of 
the  pecordial  region,  with  additional  inhibition  of  the  pneumogastric  nerves. 

Spinal  inhibition  ma\'be  carried  down  along  the  spine  as  low  as  the  6th 
dorsal  ner\'e.  Inhibition  should  be  made  upon  the  local  nerves  of  the  parts 
to  which  the  pain  has  radiated,  as  to  the  brachial  plexus,  the  cervical  and 
spinal  nerves,  etc. 

A  general  course  of  treatment,  should  be  giqen  to  strengthen  the  pa- 
tient's general  health,  to  correct  heart-action,  and  to  remove  all  lesions.  In 
this  way  much  may  be  done  to  prevent  the  recurrence  of  the  attacks,  The 
patient  should  lead  a  quiet  life  free  from  physical,  mental  and  emotional 
extremes.  In  case  of  emergency  the  use  of  the  ice  bag,  or  of  hot  appli- 
cations over  the  heart  ma\'  be  useful. 


ENDOCARDITIS  AND  MYOCARDITIS. 

These  are  inflammations  of  the  endocardium  and  of  the  heart  muscle, 
attended  b)'  various  pathological  and  degenerative  changes  in  the  part  at- 
tacked. The  extent  to  which  the  pathological  changes  go  in  most  of  these 
cases  renders  a  cure  hopeless.  All  forms  of  these  diseases  are  apt  to  pro- 
duce serious  valvular  lesions.  Aside  from  simple  acute  endocarditis,  death 
is  immanent  in  most  of  these  cases,  yet  much  may  be  done  in  individual 
cases  to  alleviate  conditions  and  to  prolong  life. 

The  Lesions  and  Anatomical  Relations  as  pointed  out  at  the  open- 
ing of  the  chapter  apply  here.  It  is  seldom  that  mj'ocarditis  or  an)-  of  the 
several  forms  of  endocarditis  seems  to  occur  idiopathically.  How  far  the 
actual  causes  of  these  diseases  may  be  shown,  from  the  accumulation  of 
osteopathic  data,  to  be  specific  osteopathic  lesions  to  the  heart  remains  to 
the  future  to  decide.  The  accepted  cause  of  these  conditions  generally  is 
the   irritation    of  the   organ  by    the  poisonous  products  of  disease.     Acute 


172  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

articular  rheumatism  is  made  accountable  for  40  per  cent  of  simple  acute 
endocarditis.  Rheumatism,  malaria,  scarlet  fever,  pulmonary  tuberculosis, 
syphilis,  gout,  lead  poisoning,  etc.,  are  looked  upon  as  the  primary  diseases 
in  which  poisonous  products  are  generated  and  cause  endocarditis  or  myo- 
carditis as  a  secondary  condition.     Various  other  causes  are  assigned. 

While  poison  in  the  system  is  admitted  by  the  Osteopath  to  be  suf^- 
cient  cause  of  disease,  it  seems  likely  that  specific  lesion  to  the  cardiac  ap- 
paratus has  much  to  do  in  weakening  the  heart  and  laying  it  liable  to  the 
invasion  of  these  diseases.  Circulation  to  the  substance  of  the  heart  is  un- 
der control  of  the  coronary  plexuses,  derived  from  the  cardiac  plexus. 
Lesion  to  the  latter  through  its  spinal  connections  may  affect  the  former 
and  disturb  the  nutrition  of  the  organ.  The  same  result  maybe  produced 
by  lesion  to  the  pneumogastries,  said  to  contain  vaso-motor  fibers  to  the 
heart  and  to  have  charge  of  trophic  condition.  It  is  obvious  that  the  usual 
cardiac  lesions  may  predispose  the  heart  to  these  diseases.  The  direct  irri- 
tation of  the  left  ribs  upon  the  heart,  when  they  are  displaced,  may  directly 
cause  pericarditis  and  myocarditis.  As  medical  etiolog)'  lays  most  of  these 
cases  to  the  action  of  bacteria,  it  is  reasonable  to  conclude  that  some  direct 
lesion  to  the  heart  deteriorates  the  vitality  of  its  tissues  and  allows  them 
to  gain  a   footholdj 

This  conclusion  is  strengthened  by  the  fact  that  endocarditis  some- 
times follows  chronic  wasting  diseases,  such  as  diabetes  and  gleetj 
The  fact  that  chronic  endocarditis  may  be  due  to  mechanicel  influ- 
ences, may  be  caused  by  heavy  muscular  effort,  straining,  etc  ,  and  the 
further  fact  that  myocarditis  is  ascribed  by  Anders  to  injuries  of  the  antero- 
lateral thoracic  region  emphasizes  the  idea  that  mechanical  lesions  regarded 
as  important  by  the  Osteopath  may  directl)-  cause  these  conditions. 

The  Prognosis  for  simple  acute  endocarditis  is  good.  It  depends 
some  upon  the  primar)-  disease.  The  prognosis  for  chronic  and  ulcerative 
endocarditis  and  for  myocarditis  is  grave.  If  specific  lesion  is  found  and 
may  be  removed,  perhaps  much  may  be  done  for  the  case — generally  speak- 
ing, much  may  be  done  in  all  of  these  cases  to  limit  the  disease  and  to  pro- 
long life.     Chronic  endocarditis  has  been  cured. 

The  Treatment  is  practicall)'  that  described  for  pericarditis,  q.  v. 
Knowledge  of  the  nerve  and  blood-supply  and  of  lesions  gives  one  the  ke\' 
to  the  situation.  The  lesion  and  all  cause  of  irritation  must  be  removed, 
and  the  patient,  in  the  acute  stages,  is  kept  in  bed  to  keep  the  heart  quiet.  In- 
hibition of  the  accelerators  and  stimulation  of  the  vagi  is  done  as  directed. 
The  ribs  are  raised  to  give  the  best  freedom,  and  the  abdominal  treatment 
may  be  applied  to  draw  the  blood  away  from  the  heart  and  aid  in  keeping  it 
quiet. 

Strict  attention  must  be  given  the  primary  disease.  In  those  generat- 
ing toxins  in  the  system  the  bowels,  kidne)S  and  liver  are  stimulated  to  ex- 
crete the  poisons.     In  the  chronic  forms  the  heart  and  its  connected  nerves 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  I  73 

may  be  carefully  stimulated  to  increase  its  tone  and    nutrition.     The    vege- 
tation in  acute  endocarditus  may  be  absorbed. 

Prophylactic  treatment  in  rheumatism  aud  in  those  diseases  leading  to 
these  conditions  consists  in  keeping  the  heart  well  stimulated,  and  in  main- 
taining free  action  of  kidneys  and  bowels  to  excrete  the  poison. 


VALVULAR  DISEASES. 

The  prog?iosis  in  cases  oi  this  kind  is  not  generally  favorable.  Asa 
rule,  valvular  disease  is  incurable.  Yet  some  cases  may  be  cured,  and  a 
fair  number  have  been  cured  by  osteopathic  treatment.  In  cases  not  cura- 
ble much  may  be  done  to  better  the  patient's  condition.  Cases  caused  by 
simple  dilatation  or  diminished  contractile  power  may  be  cured.  Also 
when  occuring  in  simple  acute  endocarditis  the  prognosis  for  cure  is  good. 

Lesions:  In  many  cases  of  valvular  lesion,  in  the  left  heart  especially, 
the  lesions  present  would  be  as  described  for  endocarditis,  to  which  disease 
these  may  be  secondary,  In  tricuspid  insufficiency  due  to  obstructed  pul- 
monary circuit  lesion  to  the  lung,  as  described  in  the  chapter  on  lung  dis- 
eases, may  cause  the  valvular  trouble. 

In  aortic  stenosis  from  increased  tension  in  the  aorta  the  condition  may 
be  due  to  lesion  to  the  diaphragm  as  explained  impeding  circulation  through 
the  aorta.  The  same  result  may  follow  extensive  arterial  obstruction,  as  of 
all  the  intercostals,  the  sub-clavians,  the  abdominals,  etc.,  as  explained 
under  Anatomical  Relations  at  the  opening  of  this  chapter,  r\ortic  valvular 
lesions  due  to  heavy  muscular  strains,  etc.,  may  be  due  to  the  presence  of 
some  one  of  the  various  lesions  described  as  affecting  the  heart,  which 
forms  a  predisposing  cause.  Lesions  to  the  vagus  and  to  the  sympathetic 
supply  of  the  heart  may  lead  to  lack  of  tone  and  diminished  contractile 
power  (See  gen.  anatomical  relations)  which  sometimes  causes  valvular  dis- 
ease. General  lesions  to  the  cardiac  mechanism,  as  of  upper  vertebrae,  ribs, 
diaphragm,  vagi  and  sympathetics,  doubtless  weaken  the  heart  and  act  as 
predisposing  causes  to  the  valvular  lesion  which  so  frequently  follows  other 
disease. 

The  Treatment  in  ordinary  cases  would  be  to  sustain  the  heart  and  to 
maintain  compensation.  It  should  look  to  the  removal  of  an)'  lesion,  or  of 
any  obstruction  to  the  blood-current,  especially  in  tricuspid  insufficiency 
caused  by  obstructed  pulmonary  circulation,  and  in  aortic  stenosis  due  to 
increased  tension  in  the  aorta.  Diaphrammatic  lesion  or  important  arterial 
obstruction  may  be  present.  In  the  obstructed  pulmonary  circulation  the 
lungs  should  be  kept  stimulated  and  any  lesion  to  the  lung  should  be  re- 
moved. In  cases  in  athletes  or  due  to  heavy  muscular  strains  one  should 
suspect  the  presence  of  definite  spinal  or  rib  lesion  due  to  such  activities. 


1/4  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

The  primary  disease  which  may  be  causing  the  trouble  calls  for  treatment 
according  to  its  kind.  In  diminished  contractile  power  or  dilatation  of  the 
left  ventricle  causing  mitral  insufficiency  the  accelerators,  should  be  stimu- 
lated, as  this  increases  cardiac  tonus  and  strenghth  of  beat,  and  contracts 
the  heart.  In  such  cases  lesion  should  be  suspected  to  the  vagus,  as  lesion 
to  bhis  nerve  may  diminish  ventricular  tonus,  dilate  the  heart,  and  weaken 
its  walls. 

In  all  such  cases  the  patient  should  lead  a  quiet  life,  free  from  excite- 
ment or  great  exertion.  He  should  be  much  out  of  doors,  and  live  upon 
a  light  nutritious  diet.  He  should  avoid  straining  at  stool,  exposure,  the 
use  of  alcohol,  tobacco,  etc.  Bathing  is  recommended  with  exception  of 
Turkish  baths. 


HYPERTROPHY  OF  THE  HEART. 

In  these  conditions  the  prognosis  is  fair.  Much  may  be  done  to  main- 
tain the  patient  in  a  state  of  comfortable  health,  preventing  dilatation. 
Cases  may  sometimes  be  cured  by  osteopathic  theropeutics.  The  prognosis 
depends  upon  that  for  the  condtion  producing  the  hypertroph\-.  In  such 
forms  of  valvulaf  diseases  as  are  curable  it  ma\'  be  cured.  In  cases  due  to 
exophthalmic  goitre  it  ma}'  be  curable. 

Such  LESIONS  as  before  described  in  cardiac  disease  may  affect  the 
nerve  connections,  etc.,  of  the  cardiac  mechanism,  and  cause  or  predispose 
to  the  condition.  A  common  cause  is  obstruction  to  the  circulation  through 
the  small  arteries.  In  the  light  of  such  fact,  lesions  before  pointed  out 
causing  obstructed  pulmonary  circulation,  obstructed  aorta,  intercostals, 
subclavians,  abdominals,  etc.,  are  important.  As  the  heart  hypertrophies 
in  valvular  disease  frequently-,  lesions  would  ha\e  to  be  sought  according 
to  primary  conditions. 

Lesion  to  the  sympathetics,  as  in  exophthalmic  goitre,  causing  hyper- 
trophy are  important.  Lesion  to  vagi  and  accelerators,  resulting  in  over- 
activity of  the  heart  ma)-  cause  hypertrophy.  When  such  simple  causes  as 
the  use  of  alcohol,  coffee,  tobacco,  etc.,  and  lead  poisoning,  etc.,  are  alleg- 
ed, one  is  bound  to  suspect  one  of  the  ordinary  lesions  present  as  the  real 
cause  allowing  the  heart  to  be  affected  by  such  agents. 

The  Treatmen'j"  looks  to  be  removal  lesion,  obstruction  to  the  blood 
flow,  etc.  It  is  directed  to  the  primar\- disease  when  the  hypertrophy,  as 
is  the  rule,  is  a  secondary  condition.  The  circulation  through  the  lungs 
should  be  kept  free.  The  patient  should  remain  quiet.  Attention  should 
be  given  the  ss-mpathetics  to  slow  the  beat  as  much  as  possible. 

The  patient  should  lead  a  quiet  life,  free  from  excitement.  His  diet 
should  be  chosen  with  care,  and  he  should  particularly  a\oid  overeating, 
alcohol,  coffee,  etc. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I75. 


DILATATION  OF  THE  HEART. 

Definition:  There  may  be  simple  dilatation  of  a  cavity,  causing  in- 
crease in  its  size  and  thinning  of  its  walls.  The  dilatation  ma)-  be  accom- 
panied with  hypertrophy,  in  which  there  is  both  increase  in  the  size  of  the 
cavity  and  in  the  thickness  of  the  muscular  wall. 

As  to  CAUSES,  the  lesions  as  discussed  would  be  sufficient.  No  specific 
lesion  has  been  pointed  out  for  this  condition.  Lesions  to  the  cardiac 
mechanism  weaken  the  heart  and  thus  are  especially  apt  to  predispose  to 
dilatation.  Under  such  conditions  o\'er-exertion  and  great  physical  strain 
would  be  more  likely  to  cause  dilatation  of  the  right  ventricle.  As  the 
vagus  nerve  has  been  shown  to  have  a  trophic  influence  upon  the  heart 
walls,  also  upon  their  dilatation,  lack  of  tone,  and  a  softened  condition  of 
them,  lesion  to  it  would  have  an  important  part  in  the  production  of  dilata- 
tion. Obstructed  circulation,  and  any  cause  producing  increased  intra-  car- 
diac pressure  may  result  in  dilatation.  This  is  seen  in  mitral  diseases.  Os- 
teopathic lesion  causing  obstruction  or  the  aorta  by  the  diaphragm,  obstruc- 
tion to  the  intercostals,  abdominals,  pulmonar)'  circulation,  etc.,  as  before 
discussed,  may  become  the  direct  cause  of  dilatation  of  the  heart. 

The  Prognosis  is  not  good.  It  depends  upon  that  for  the  primary  con- 
dition often,  as  in  valvular  diseases  where  the  prognosis  is  bad.  When  due  to 
specific  removable  lesion  the  prognosis  ma)'  become  favorable. 

The  TREATMENT  consists  in  righting  of  mechancal  relations  and  re- 
mo\'al  of  lesion.  Obstruction  to  the  circulation  must  be  relieved,  and  heart 
and  lungs  must  be  kept  well  stimulated  to  empt)'  the  chambers  of  the  heart 
of  the  clotted  blood  that  is  retained  in  them.  Stimulation  of  the  accelera- 
tors aids  the  process  by  steadying  and  strengthening  the  heart  beat,  con- 
tracting it  and  adding  tone. 

When  secondary  to  acute  infectious  disease,  vah'ular  disease,  etc.,  the 
primar)-  condition  must  be  treated.  The  dropsy  and  dyspepsia  j)resent  de- 
pend upon  the  bad  circulation  and  are  treated  in  the  usual  wa\-s.  Stimula- 
tion of  the  lungs  and  raising  the  ribs  relieve  the  dyspnea.  Stimulation  to 
the  kidneys  increases  the  flow  of  urine,  which  has  been  lessened,  and  aids 
in  overcoming  the  dropsy. 

In  the  acute  form  the  patient  should  rest  in  bed.  In  the  chronic  form 
he  should  avoid  fatigue'  Genaral  directions  for  the  care  of  the  patient  are 
as  before  gi\'en. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHi^.  I79 


DISEASES  OF  THE  NERVOUS  SYSTEM. 

CHOREA.     (St.  Vitus  Dance.) 

Definition:  A  disease  of  the  nervous  system  characterized  by  in- 
voluntary contraction  of  muscle  groups,  accompanied  by  weakness,  and 
often  by  slight  mental  derangement,  due  to  spinal  lesions  interfering  with 
motor  function  of  brain  or  cord. 

Cases:  (i)  A  case  in  a  young  girl,  of  three  or  four  months  standing; 
very  severe;  had  lost  all  control  of  hands  and  feet,  and  of  speech;  could 
lake  only  liquid  food.  It  was  thought  she  could  not  live.  Lesions  were 
found  at  the  atlas  and  4th  dorsal  uertebrae.     The  case  was  cured. 

(2)  In  a  boy  of  nine,  chorea  followed  vaccination.  Lesion  was  found 
at  the  atlas  and  at  the  2d  to  4th  dorsal  vertebrae.  Case  cured  in  five  weeks. 

(3)  A  case  in  a  child  of  eleven,  of  nine  months  standing.  Very  se- 
vere; no  sleep  for  six  nights;  power  of  articulation  was  lost.  Six  weeks  of 
treatment  showed  great  improvement. 

(4)  A  girl  of  ten;  marked  lesion  of  the  atlas,  and  of  the  3d  and  4th 
cervical  vertebrae;  the  2d  to  6th  dorsal  vertebrae  were  irregular  and  lateral; 
5th  lumbar  posterior;  cured  in  four  manths. 

(5)  Case  of  two  years'  standing  in  a  bo}'  of  twelve;  right  hand  useless 
and  carried  in  a  sling;  lesion  at  ist  to  3d  dorsal.  Under  treatment  he  be- 
came able  to  write  well  in  one  month.     The  case  was  cured. 

(6)  A  case  of  two  years'  standing  in  a  girl  of  thirteen.  She  had  grown 
continually  worse  under  usual  treatment.  The  atlas  was  found  displaced 
to  the  left,  and  upon  its  being  replaced  at  the  second  treatment  the  jerk- 
ing of  the  muscles  began  to  grow  less  at  once.  The  case  was  cured  in  one 
month,  and  the  child,  previously  undersized,  grew  rapidly  thereafter. 

(7)  The  patient  was  a  girl  of  thirteen;  confined  to  the  bed;  arms  and 
limbs  drawn  and  useless;  she  could  not  sleep  or  speak  intelligently.  Bony 
lesions  were  found  in  the  cervical  and  lower  dorsal  regions,  and  all  the 
spinal  muscles  were  contractured.  The  case,  of  three  months'  standing, 
was  cured  in  one  month. 

Lesions  and  Anatomical  Relations:  The  lesions  in  these  cases 
are  found  in  the  majority  of  cases  in  the  upper  dorsal  and  cervical  regions. 
Six  of  the  above  seven  cases  described  lesion  and  are  illustrative  of  the 
facts  generally  observed  in  such  cases.  All  showed  lesion  in  the  cervical 
or  upper  dorsal  region,  one  or  both.  Neck  lesion  is  important  in  these 
cases. 

Five  of  the  above  showed  cervical  lesion,  four  of  the  five  being  atlas 
lesions.  The  fact  that  atlas  lesions  alone  may  cause  the  disease  is  illus- 
trated by  case  (6)  The  fact  that  the  upper  dorsal  lesion  alone  may  cause 
it  is  illustrated  by  case  (5).  But  frequently,  as  in  three  of  those  reported, 
combined  lesion  of  the  cervical  and  upper  dorsal   regions    occur.     The  up- 


I  So  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

per  dorsal  lesion  is  perhaps  the  most  important  one.  Four  of  the  above 
six  showed  lesion  somewhere  in  the  upper  six  dorsal  vertebrae.  The  spinal 
area  from  the  atlas  to  the  6th  dorsal  may  be  regarded  as  the  important 
locality  for  lesions  producinor  chorea.  They  may  occur  lower  or  affect  the 
ribs  as  well  as  vertebrae. 

These  lesions  high  up  in  the  spine  ma}'  involve  the  cord  and  brain,  in 
a  similar  manner  but  lesser  degree,  as  in  paralytic  affections  of  the  whole 
body.  The  frequent  occurrence  of  high  lesion  explains  the  usual  general 
effect  of  the  disease  upon  the  whole  body,  including  the  upper  and  lower 
limbs  and  suggests  the  idea  that  the  cord,  brain,  or  both  are  involved  by 
the  lesion. 

The  authors  state  that  the  pathology  of  this  condition  is  obscure,  no 
constant  lesions  being  found.  Probably,  as  McConnell  observes,  this  is  due 
to  the  fact  that  spinal  lesion  may  often  involve  simply  nerve-fibers.  Some 
writers  hold  the  disease  to  be  a  functional  brain  disturbance  affecting  the 
centers  controlling  the  motor  apparatus.  From  this  point  of  view  cer\ical 
and  atlas  lesion  have  an  important  bearing,  as  they  may  influence  brain 
centers  by  interference  with  blood-supply  to  the  brain  through  direct  im- 
pingement upon  the  vertebral  arteries  and  by  disturbance  of  the  cervical 
sympathetics.  Upper  dorsal  lesion  may  aid  this  effect  by  sympathetic  dis- 
turbance. From  this  view  either  atlas,  other  cervical,  or  upper  dorsal  les- 
ion alone  could  cause  the  disease. 

It  is  worthy  of  note  that  the  upper  dorsal  lesion  (ist  to  6th)  falls  upon 
a  portion  of  the  cord  richer,  perhaps,  than  any  other  in  sympathetic  cen- 
ters. The  cilio-spinal  center,  vaso-motors  to  face  and  mouth,  pupillo-di- 
lator  fibers,  motor  fibers  to  involuntary  muscles  of  the  orbit,  vaso-motors  to 
the  lungs,  accelerators  to  the  heart,  etc.,  all  occur  within  this  spinal  area. 
This  disturbance  to  the  sympathetic  may  have  much  to  do  in  unbalancing 
the  nervous  system  in  such  cases.  This  lesion  could  also  effect  spinal  fibers 
by  impingement  or  the  nutrition  of  the  cord  through  sympathetic  disturb- 
ance of  its  blood-supply. 

On  the  whole  the  likely  patholog)'  in  this  disease  is  that  there  is  cord 
lesion  or  brain  lesion  due  to  mechanical  irritation  or  to  cut  off  nutrition. 
These  various  lesions  weaken  the  portions  of  the  nerve-system  involved, 
and  lay  it  liable  to  the  action  of  such  reflex  causes  as  irritation  due  to  para- 
sites, eye-strain,  nasal  disease,  sexual  disorders,  etc.,  or  to  such  causes  as 
over-study,  shock,  worry,  strain,  etc. 

The  Prognosis  is  good.  It  is  rare  that  the  treatment  fails  to  cure  or 
greatly  relieve  the  case.  Cure  in  a  short  time  is  the  rule,  even  in  serious 
and  long-standing  cases. 

The  Treatment  consists  mainly  in  removal  of  lesion  as  the  real  cause. 
In  some  cases  this  is  the  sole  treatment  necessary.  Ordinarily  it  is 
necessary  to  carry  the  patient  through  a  course  of  treatment.  All  causes 
of  irritation  or  nerve-strain  should  be  removed.    Such  are  intestinal    worms, 


PRACTICE  AMD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  l8l 

causes  of  worry,  etc.,  as  noted  above.  An  important  measure  in  these 
cases  is  the  treatment  upon  the  neck  and  spine  for  the  general  nervous 
system.  The  neck  treatment  reaches  the  sympathetic  system,  the  medulla, 
the  circulation  to  the  brain,  and  influences  the  whole  nervous  system.  It 
consists  of  the  removal  of  lesion,  relaxation  of  tissues,  inhibition  or  stimu- 
lation of  the  cervical  nerves  and  centers,  etc.  The  spinal  treatment  is  upon 
the  same  plan.  It  should  be  carried  down  along  the  spine.  These  treat- 
ments quickly  relieve  nervous  tension  and  quiet  the  nervous  system.  They 
correct  the  circulation  to  the  brain  and  central  nervous  system,  increasing 
their  nutrition,  and  stopping  the  muscular  twitching  characteristic  of  these 
conditions.  An  important  treatment  is  the  removal  of  contracture  of  the 
muscles  all  along  the  spine,  common  in  these  cases.  Attention  must  be 
given  to  the  patient's  general  health.  The  heart  is  often  very  fast  and 
should  be  slowed  in  the  way  already  described.  The  kidneys  should  be 
stimulated  and  general  metabolism  in  the  body  looked  to,  to  increase  the 
too  light  specific  gravity  of  the  urine.     The  bowels  must  be  kept  regular. 

A  thorough  general  treatment  should  be  given  to  the  muscular  system, 
especially  to  those  muscle  groups  involved  in  the  disease.  This  includes 
flexion  and  circumduction  of  limbs  and  arms,  etc. 

In  some  cases  inhibition  of  the  cervical  sympathetic  will  cause  the 
muscular  twitching  to  cease  at  once.  It  has  been  accomplisned  by  pressure 
between  the  3d  and  4th  cervical  vertebrae. 

In  the  hygienic  treatment  of  the  case  all  causes  of  ner\e-strain,  over- 
work mentally,  excessive  physical  exertion,  etc.,  must  be  removed.  Mus- 
cular exertion  may  lead  to  heart  involvement,  especially  as  cervical  and 
upper  dorsal  lesion  favor  such  conditions.  The  diet  should  be  light  and 
nutritious.  Fruits  and  vegetables  may  be  taken,  but  meats  and  highly 
seasoned  foods  should  be  avoided.  Sponging  of  the  back,  chest  and  neck 
with  cold  vv^ater  is  useful. 

The  various  Choreiform  Affections,  such  as  the  spasmodic  ties,  habit 
chorea,  laryngeal  tic,  choreic  wry-neck,  facial  tic,  jumping  disease,  etc.,  also 
rhythmic  or  hysteric  chorea,  fibrillar)'  chorea,  athetosis,  and  varions  other 
forms,  are  met  in  the  same  way. 

Huntingdon's  chorea;  a  hereditary  disease  with  progressive  dementia, 
is  a  very  grave  disease.  There  is  no  record  of  its  ever  having  been 
treated  osteopathically. 


EPILEPSY. 

Definition:  A  disease  in  which  there  is  loss  of  consciousness,  with  or 
without  convulsions.  From  the  osteopathic  point  of  view  it  is  caused  by 
lesions  interfering  with  the  nutrition  of  cord  or  brain,  or  irritating  the  motor 
nerve  strands  running  to  the  peripheral  motor  structures,  or  exciting  con- 
nected nerves. 


l82  PRACTICE  AND  AI'PLIED  THERAPEUTICS    OF  OSTEOPATHY. 

Cases:  (i)  A  case  showing  lesions  at  7th  and  nth  dorsal  vertebrae. 
Under  the  treatment  the  attacks  were  much  decreased  in  frequenc)-,  not 
having  appeared  for  a  considerable  period. 

(2)  A  case  of  more  than  one  year's  standing  in  a  girl  of  thirteen;  three 
to  twelve  attacks  daily;  lesions  in  upper  cervical  spine,  posterior  curvature 
from  6th  dorsal  to  lower  lumbar,  marked  lesions  occuring  at  the  6th  dorsal 
and  at  the  5th  lumbar;  all  spinal  muscles  very  rigid.  Improvement  began 
at  once  upon  treatment,  and  the  case  was  cured  in  three  months. 

(3)  A  case  of  fifteen  years'  standing  in  a  man  of  thirty.  No  attacks  oc- 
cured  after  the  first  treatment,  and  the  case  was  cured  in  four  months.  No 
recurrence  of  attacks  nineteen  months  later. 

(4)  A  case  of  twelve  )'ears'  standing  in  a  bo)'  of  twelve  cured  by  the 
treatment. 

(5)  Daily  attacks  in  a  bo\' of  eighteen,  apparently  due  to  a  nervous 
stomach  disease.  The  latter  was  cured  in  three  months,  and  no  further  at- 
tack had  occured  six  months  afterward. 

(6)  A  case  of  fourteen  years'  duration  in  a  lady  of  eighty  was  cured  in 
two  treatments.  No  attack  occured  after  the  first  treatment.  The  report 
was  made  two  and  a  half  )-ears  after  the  cure,  no  further  attack  having  oc- 
cured. 

(7)  In  a  boy  of  twelve,  monthly  spells  of  two  days'  duration  occured, 
during  which  he  would  have  from  three  to  fi\'e  spasms.  The  3rd  cervical 
vertebra  was  found  turned  far  to  the  right.  Under  a  three  months'  course 
of  treatment  he  had  not  had  the  last  two  monthly  spells. 

(8)  A  case  of  petit  mal  in  ajoung  man  of  thirty.  Lesions  at  the  atlas, 
which  was  to  the  right  and  turned  with  the  right  transverse  process  back- 
ward, and  at  the  axis,  displaced  to  the  left.     Case  still  under  treatment. 

Lesions  and  Anatomical  Relations:  It  seems  that  lesion  along  the 
neck  and  spine  anywhere  may  cause  epilepsy — Dr.  A.  T.  Still  is  credited 
with  the  statement  that  there  is  usually  lesion  between  the  2nd  and  3rd 
cervical  vertebrae.  Lesions  in  the  above  cases  occured  at  the  atlas,  cervical 
region,  and  from  the  middle  dorsal  down  to  the  last  lumbar.  McConnell 
states  that  lesions  occur  often  in  the  splanchnic  area  and  to  the  ribs,  especi- 
ally in  the  spinal  region  between  the  4th  and  8th  dorsal  vertebrae,  also  that 
the  prominent  lesions  occur  in  the  neck  from  the  3rd  to  7th  \ertebra.  He 
notes  a  case  caused  by  displacement  of  the  right  5th  rib.  An  attack  could 
be  caused  by  irritation  of  this  lesion,  or  be  relieved  at  once  by  replacing 
the  rib. 

The  neck  lesion  seems,  on  the  whole,  to  be  the  most  important.  Neck 
and  spinal  lesion  may  act  b>'  obstructing  the  blood-supply  to  brain  or  cord. 
They  may  affect  the  cord  directly  by  mechanical  irritation,  or  may  affect 
brain,  cord,  or  nervous-system  generally  through  the  sympathetics.  In 
this  way  they  may  bring  about  these  morbid  conditions  of  cord,  brain  and 
and  meninges    said  to  cause  the  disease.     While  the  pathology  of  epilepsy 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  1 83 

is  unknown,  it  yet  appears  that  osteopa  thic  lesion  may  account  from  any  of 
the  various  conditions  assigned  as  causes.  Such  lesions,  disturbing  the 
sympathetic  system,  may  act  as  does  peripheral  irritation  from  dentition, 
worms,  cicatrices,  adherent  prepuce,  etc.  Various  of  these  lesions  may 
directly  irritate  peripheral  ner\'e  structures.  As  traumatism  is  assigned  as 
a  cause,  osteopathic  lesion  as  cause  or  effect  of  traumatic  conditions  may 
be  the  real  cause. 

According  to  Gray  the  best  accepted  modern  theory  of  the  cause  of 
epilepsy  is  that  it  is  due  to  direct  or  indirect  excitation  of  the  cortex  or  of 
the  nerve- strands  leading  fj-om  the  cortex  to  the  peripheral  ctncctures;  that  there 
is  3.  peculiar  violecnlar  condition  of  the  motor  tract  ivhich  runs  from  the  motoi  con- 
volutions to  the peripheial  motor  structures  and  muscles.  He  states  that  we  are 
ignorant  of  the  nature  of  this  molecular  condition;  that  muscles  can  be 
convulsed  only  by  direct  excitation  of  the  muscle  itself,  or  of  the  motor 
tract  leading  from  the  muscle  up  to  the  motor  convolutions;  but  that  same 
varieties  of  epilepsy  are  evidenly  due  to  an  excitation  that  extcnde  into  this 
motor  tract  from  some  part  of  the  nervous  system  beyond  it.  It  would  seem  clear 
that  osteopathic  lesion  may  irritate  these  motor  tracts  somewhere  in  their 
course,  as  by  direct  pressure  of  luxated  spinal  vertebrae,  etc.,  or  that  in  a 
multitude  of  wa)'s  it  may  produce  excitation  in  some  other  part  of  the 
nervous  system  from  which  it  extends  to  the  motor  tract.  As  nerve  irrita- 
tion by  lesion  is  the  important  point  in  osteopathic  etiolog)'  generally,  be- 
ing well  supported  by  numerous  instances  in  which  its  removal  has  cured 
the  disease,  it  is  a  reasonable  conclusion  that  the  various  bony  lesions  found 
in  epilepsy  are  causing  it  by  excitation  of  the  sort  mentioned.  This  point 
is  likewise  supported  by  the  fact  that  removal  of  such  lesion  has  often 
cured  epilepsy. 

The  Prognosis  is  fair  in  the  ordinary  case,  a  fair  number  of  the  cases 
coming  under  osteopathic  treatment  being  cured  entirel}'.  A  large  per- 
centage not  cured  are  benefitted.  There  seems  to  be  but  little  difference  in 
the  prognosis  in  favor  of  petit  mal.  In  Jacksonian  Epilepsy  the  prognosis 
is  not  good. 

Treatment:  At  the  time  of  attacks  but  little  can  be  done  for  the 
patient.  If  the  patient  can  be  reached  at  the  aura  the  attack  may  be  pre- 
vented by  pushing  the  patient's  head  strongly  back  against  a  hand  apply- 
ing deep  pressure  in  the  sub-occipital  fossae.  This  treatment  seems  to 
arouse  reflex  stimulation  or  to  equalize  blood-flow  to  the  brain  by  affect 
upon  the  superior  cerxical  ganglion  and  medulla. 

Anders  states  that  constriction  of  the  limb  in  which  the  aura  occurs, 
forcibly  moving  the  patient's  head,  placing  snuff  to  the  patient's  nose,  ap- 
plying ice  to  his  spine,  etc,,  will  sometimes  prevent  the  attack.  McConnell 
calls  attention  to  the  fact  that  in  cases  where  ;he  exciting  factor  seems  to 
be  in  the  intestine  and  there  is  reversed  peristalsis  of  the  intestines,  causing 
a  reversion  of  the  nerve    current    in    the   vagi,    thorough    rapid   abdominal 


l84  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

treatment  will  normalize  peristalsis  and  aid  in  preventing  an  impending  at- 
tack. Stimulation  of  the  solar  plexus  may  lesson  the  attack  by  calling  the 
blood  to  the  intestines  and  thus  reducing  pressure  in  the  cranium. 

At  the  time  of  the  attack  the  patient  must  be  prevented  from  having 
serious  falls,  if  possible.  The  clothing  about  the  neck  should  be  loosened 
so  that  it  may  not  restrict  circulation.  Some  object  should  be  slipped  be- 
tween the  tecih  to  prevent  the  patient's  biting  his  tongue.  .Small  objects 
that  may  fall  into  the  wind-pipe  should  not  be  used  for  this  purpose. 

A  general  course  of  treatment  is  depended  upon  to  prevent  recurrence 
of  attacks  and  to  cure  the  case.  This  consists  in  the  removal  of  lesion, 
whatever  it  be,  and  of  all  causes  of  reflex  irritation  mentioned  above.  It  is 
especiall)'  important  to  remove  lesion  acting  to  irritate  the  motor  fibers  of 
the  central  nervous  system,  in  view  of  the  fact  pointed  out  above  that  such 
excitation  is  probably  the  most  efficient  cause  of  epilepsy.  Treatment 
should  be  given  to  correct  blood-flow  to  and  from  the  brain,  including  such 
treatments  as  opening  the  mouth  against  resistance,  treatments  above  the 
course  of  the  carotids,  elevation  of  the  clavicles,  treatment  of  the  cervical 
sympathetics,  etc.  Attention  should  be  given  to  upbuilding  the  general 
health,  and  to  keeping  towels  and  stomach  in  good  condition.  All  causes 
of  worry  or  nerve-strain  should  be  avoided  and  the  patient  should  lead  an 
out-door  life.  The  food  should  be  light  and  easily  digested,  consisting  of 
some  meat,  fruit,  vegetables,  cereals,  etc.  Cold  sponge  baths  are  recom- 
mend eti. 


MIGRAINE.  (Hemicrania,  Sick  Headache)  and  OTHER  FORMS  OF 
HEADACHE  (Cephalalgia). 

Definition  :  Migraine  is  "a  neurosis  characterized  by  severe  attacks 
of  headache,  often  paroxysmal  and  more  or  less  periodic,  with  or  without 
nausea  and  vomiting."  It  is  of  obscure  pathology;  there  seems  to  be  noth- 
ing to  connect  it  with  stomach  lesion,  and  from  an  osteopathic  point  of 
view  it  is  generally  found  to  be  due  to  cervical  bony  lesions. 

Headache  is  the  general  term  used  to  describe  pain  in  the  head.  It 
may  be  either  symptomatic  or  idiopathic,  the  latter  being  generally  chronic 
and  due  to  specific  bony  lesion,  usually  in  the  cervical  vertebrae.  A  large 
class  of  the  latter  come  under  osteopathic  treatment,  generally  in  very  bad 
condition  after  having  suffered  far  beyond  the  power  of  drugs  to  cure. 
These  may  almost  be  considered  as  suffering  from  a  hitherto  undescribed 
form  of  headache,  depending  upon  specific  lesion,  often  the  result  of  acci- 
dent, and  usually  immediately  relieved  and  cured  upon  removal  of  the 
lesion.  The  form  embraces  many  of  the  kinds  of  heahache  generally  de- 
scribed under  one  or  other  of  the  usual  classifications. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I85 

Cases  :  (i)  Extremely  severe  frontal  headache  in  a  man  of  thirty- 
two,  since  boyhood.  He  had  taken  e\ery  known  remedy  without  avail. 
Lesions  were  found  in  muscular  contractions  on  the  right  side  of  the  neck; 
the  dorsal  spine  was  anterior  in  its  upper  half;  the  nth  dorsal  vertebra 
was  luxated  to  the  left  ;  the  2d  and  5th  lumbar  vcrtcbiae  were  prominent  ; 
the  sacrum  was  tilted  forward  and  the  left  innominate  was  slipped,  length- 
ening the  limb.     The  lesions  were  corrected  and  the  case  cured. 

(2)  Nervous  headache  of  years'  standing  in  a  lady  was  cured  in  three 
months. 

(3)  Chronic  headache  of  twenty  years'  standing  cured  in    six    weeks. 

(4)  Acute  headache,  very  severe;  pulse  128,  temperature  1033-5°; 
relieved  in  one  treatment  and  soon  cured. 

(5)  Migraine  in  a  man  of  thirty,  since  his  sixteenth  year,  when  he 
fell  from  a  wagon.  Lesion  existed  at  the  3d  cervical  vertebra  and  at  the 
atlas.     The  case  was  relieved  at  once  and  cured. 

(6)  In  a  boy  of  twelve  a  very  severe  headache  was  caused  by  a  fall 
on  his  head  from  a  bar  in  the  gymnasium.  The  atlas  was  found  displaced 
laterally,  and  the  case  was  cured  in  two  treatments. 

(7)  Li  a  chronic  case  of  occipital  headache  persistmg  for  years,  no  or- 
dinary remedy  would  affect  the  condition.  The  atlas  was  found  slipped  and 
the  muscles  about  it  very  much  contracted  and  tender.  Relief  was  given 
at  one  treatment,  and  the  case  was  practically  cured  in  one  month. 

(8)  Migraine,  with  constipation,  stomach  disease,  temporar)'  blind- 
ness, etc.,  was  cured  in  nine  months. 

(9)  A  man  of  forty-five,  troubled  for  many  years  by  occipital  head- 
ache, mostly  upon  the  left  side.  Lesion  was  found  at  the  atlas,  impinging 
upon  a  cervical  ner\  e.     Cure  was  accomplished  in  two  months. 

(10)  In  a  lady  of  thirty  there  was  constant  occipito-frontal  headache. 
The  eyes  were  weak  and   painful;    the  glasses    had    been    changed    six 

times  in  one  year.  The  muscles  of  neck  and  shoulder  were  found  much 
contracted,  the  atlas  was  luxated  to  the  right  and  painful  upon  pressure. 
But  one  severe  headache  occurred  during  one  month's  treatment,  and  the 
e}'es  were  much  improved.  In  two  months  the  glasses  were  laid  aside  and 
the  headache  was  cured. 

(11)  Headache,  with  blind  spells,  in  a  woman  of  forty-one;  the  ist 
and  2d  cervical  vertebrae  were  approximated  and  sore;  the  muscles  of  the 
upper  cervical  region  very  tense;  headache  constant;  ist  to  8th  dorsal  ver- 
tebrae were  flattened  anteriorly;  nth  dorsal  to  3d  lumbar  posterior.  The 
patient  had  suffered  a  sunstroke,  and  had  had  two  or  three  attacks  month- 
ly since. 

(12)  Congestive  headache  in  a  man  of  thirty-seven,  of  twelve  years' 
standing.  Violent  attacks  occurred  daily,  and  ever)'  known  remedy  had 
been  used  in  vain.     The  sole  lesion    was    a    depressed    clavical    interfering 


l86  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

with  the  venous  flow  from  the  head.     Two    treatments  restored  the  bone  to 
place  ann  cured  the  case. 

(13)  Catamenial  headache  (migraine)  occurred  each  month,  lasting 
two  or  three  days.  It  was  of  six  years'  standing.  A  cure  was  made  in  two 
month's  treatment,  no  headache  occurring  after  the  first  treatment. 

(14)  Chronic  headache  of  four  years'  standing,  caused  by  a  fall  upon 
the  back  of  the  head,  which  rendered  the  neck  partly  stiff.  There  was  con- 
tracture of  the  tissues  over  the  spinous  process  of  the  axis,  which  was  dis- 
placed to  the  right.     After  four  treatments  the  pain  had  disappeared. 

Lfsions  :  Migraine,  with  other  forms  shows  the  usual  lesions.  Le- 
sions found  to  produce  it  are  of  the  atlas  :  1st,  2nd  and  3d  cervical;  upper 
dorsal;  8th,  gth  and  loth  dorsal;  7th  and  8th  ribs. 

When  headache  is  symptomatic  purely,  lesion  depends  upon  the  pri- 
mary diseae,  but  specific  lesion  is  often  present  and  determines  the  effect 
in  the  head. 

Nine  of  the  above  fifteen  cases  report  les'on,  Kic^ht  of  the  nine  were 
cervical  lesions;  one  was  clavicular;  six  of  the  eight  cervical  were  of  the 
atlas.  Atlas,  axis,  cervical,  and,  to  some  extent,  spinal  lesions  are  the 
important  ones  producing  headache.  They  result  in  chronic,  idiopathic 
headaches.     Often  these  may  develop  into  insanity. 

Lesions  act  by  disturbing  sympathetic  relations,  reflexl\-  causing  the 
headaches,  just  as  may  be  the  case  in  reflex  headache  from  uterine  prolapsus. 
They  all  act  by  stoppage  of  blood-flow.  This  may  occur  in  several  ways. 
The  vertebral  arteries  may  be  occluded  by  pressure  from  the  displaced  cer- 
vical vertebra;  the  clavicle  may  hinder  venous  flow  in  the  external  and  in- 
ternal jugulars,  the  sympathetic  irritation  nia\'  set  up  vaso-motor  reflexes 
prevent  proper  circulation.  A  lesion  may  cause  headache  by  direct  press- 
ure of  the  luxated  vertebra  upon  a  nerve-fibre.  A  very  common  place 
for  this  to  occur  is  at  the  atlas  which  impinges  branches  of  the  of  the  sub- 
occipital nerve  sent  to  supply  the  occipito-atlantal  articulation.  The  same 
thing  is  apt  to  occur  at  any  of  the  upper  three  cervical  vertebrae,  the  corres- 
ponding nerves  sending  branches  to  supply  sensation  to  the  scalp.  Con- 
traction of  tissues  over  branches  of  the  fifth  nerve,  or  at  their  fo- 
ramia  of  exit  may  cause  headache.  Reflex  or  direct  irritation  of  the 
fifth  nerve  ma)-  cause  it. 

The  kinds  of  pain  in  headache  aid  in  diagnosing  the  variety.  Dana 
notes  the  fact  that  a  pulsating  or  throbbing  pain  occurs  in  headache  due  to 
vaso-motor  disturbance,  as  in  migraine,  a  dull.  hea\\'  pain  in  toxic  or  dys- 
peptic forms;  a  constrictive,  squeezing,  or  pressing  pain  in  neurotic  or  neu- 
rasthenic cases;  a  hot,  burning,  or  sore  pain  in  rheumatic  or  anemic  head- 
ache; a  sharp,  boring  pain  in  hysteric,  epileptic,  or  neurotic  forms. 

The  pain  is  usually  found  to  be  localized  in  or  referred  to  the  peri- 
pheral ends  of  the  fifth  nerve,  they  supplying  the  antero-lateral  parts  of  the 
scalp  and  the  dura  mater  with  sensation.     Hence  treatment  is    directed    to 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


187 


.^ 


the  branches  of  the  fifth  nerve  upon  the  face  and  scalp.  The  chief  local 
treatment  in  occipital  headache  is  made  to  the  upper  four  cervical  nerves, 
as  their  branches  are  here  involved. 

The  Prognosis  is  good  in  all  forms  of  headache,  even  in  migraine.  The 
most  long  standing  and  severe  cases  yield  readily  to  treatment,  even  when 
all  other  remedies  have  failed. 

The  Treatment  described  will  apply  to  any  of  the  numerous  kinds  of 
headache  described,  though  special  postions  of  the  treatment  laid  down 
may  apply  to  an}' given  case  as  sufficient  for  it.  The  treatment  must  be 
adapted  to  the  case,  each  one  needing  a  special  study  of  its  features  to 
enable  one  to  discover  the  cause  and  apply  the  proper  treatment.  The 
treatment  successful  in  one  case  ma)'  not  apply  to  another. 

The  lesion  must  be  removed,  and  this  often  constitutes  the  sole  treat- 
ment necessary.  All  causes  of  irritation  must  be  removed,  such  as  eye 
strain,  sympathetic  disturbance,  uterine  or  stomach  disease,  etc.  Ordinarily 
the  first  step  is  the  relaxation  of  contractured  muscles  in  the  neck  and 
upper  dorsal  region.  This  relives  irritation  to  nerv  es,  frees  circulation 
and  prepares  for  the  replacing  of  a  displaced  vertebra.  Attention  should 
be  given  to  freeing  all  points  of  venous  flow  from  the  head.  Treatment 
may  be  made  in  the  course  of  the  veins  across  the  forehead  to  the  outer 
canthus  of  the  eye  and  down  toward  the  angle  of  the  jaw,  along  the  jugular 
veins,  raising  the  clavicle  and  relaxing  all  the  tissues. 

Inhibition  along  the  back  and  sides  of  the  neck  in  the  region  of  the 
upper  four  vertebrae,  and  in  the  sub-occipital  fossae  quiets  the  upper  four 
cervical  nerves  and  aids  in  restoring  equality  of  circulation  through  affect 
upon  the  superior  cervical  ganglion. 

Often  pressure  made  as  follows  is  efficient:  in  the  mid-line  of  the  neck, 
just  below  the  occiput;  below  the  ears,  upon  and  below  the  transverse  pro- 
cesses of  the  atlas;  along  the  upper  dorsal  region  at  the  upper  three  or  four 
vertebrae.  These  treatments  quiet  cerebro-spinal  nerves  and  correct  vaso- 
motion. 

Treatment  should  be  made  upon  the  face  over  the  points  of  the  fifth 
nerve  (Chap.  V.  B).  Relax  tissues  over  the  nerves  and  at  the  foramina. 
Manipulation  to  relax  the  tissues  all  along  the  course  of  the  longitudinal, 
sinus,  from  nasion  to  occipital  protuberance,  and  thence  laterally  toward  the 
mastoid  processes,  over  the  course  of  the  lateral  sinuses,  aids  in  freeing  the 
circulation  in  them.  As  this  treatment  is  carried  over  the  vertex  the  ter- 
minals of  the  various  sensory  nerves  of  the  scalp  are  affected    and    quieted. 

Deep  pressure  over  the  solar  plexus  and  inhibitive  abdominal  treat- 
ment aid  in  relieving  the  headache  some  times  by  quieting  the  reflexes  and 
calling  the  blood  awa\-  from  the  head. 

Exciting  causes  should  be  avoided.  It  is  well  in  such  cases  as  need  it 
to  give  attention  to  regulating  the  condition  of  stomach  and  bowels.  Cold 
applied  to  the  forehead  and  temples,  and  heat  applied  to  the  base  of  the 
skull  and  the  extremities  aid  in  relief. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV.  I89 


LOCOMOTOR  ATAXIA  AND  SPASTIC  PARAPLEGIA. 

Definition:  Locomotor  Ataxia,  or  Tabes  Dorsalis,  is  a  disease  charac- 
terized by  sclerosis  of  the  posterior  columns  of  the  cord,  loss  of  co-ordina- 
tion in  the  muscles  of  the  limbs,  absence  of  the  patellar  reflex,  lightning 
pains  in  the  limbs,  and  the  Argyll-Robertson  pupil,  which  reacts  to  ac- 
comodation but  not  to  light. 

Cases:  (i)  In  a  woman  of  thirty-two,  lesions  were  found  at  the  atlas 
and  upper  lumbar  region.  Under  treatment  she  regained  control  of  bladder 
and  bowels,  became  able  to  walk  well,  and  the  progress  of  the  disease  had 
apparently  been  terminated. 

(2)  In  a  man  of  twenty-nine,  the  lesion  was  a  complex  curvature  of 
the  spine.  It  was  lateral  to  the  right  from  the  5th  dorsal  to  2nd  lumbar, 
and  posterior  in  the  lower  lumbar  region,  being  so  marked  that  the  left 
lower  ribs  came  within  the  iliac  fossa,  while  the  right  ones  descended  over 
the  hip.  The  whole  thorax  was  misshaped.  The  right  limb  was  atrophied 
to  one-half  its  original  size.  After  eight  months'  treatment  the  patient 
could  walk  thirty-five  blocks  without  a  cane;  his  general  health  was  good, 
and  'he  disease  was  showing  rapid  improvement. 

(3)  A  case  in  a  }'oung  man  of  twenty,  in  which  there  was  marked 
scoliosis  of  the  dorsal  spine,  involving  the  thorax,  some  improvement  in 
the  locomotor  ataxia  was  gained  under  treatment. 

(4)  A  case  in  a  man  of  thirty-five  showed  spinal  lesion  in  the  dorsaF 
spine  between  the  shoulders,  the  vertebrae  being  irregular  and  posterior. 
Under  continued  treatment  his  walking  was  much  improved,  visceral  crises 
were  prevented,  the  control  of  bladder  and  rectum  were  regained,  and  the 
pains  in  the  lower,  limbs  were  done  away. 

(5)  A  case  which  could  not  rise  from  his  chair  nor  walk,  could  do 
both  after  three  weeks'  treatment. 

(6)  A  case  of  eleven  years'  standing  in  a  man.  In  several  weeks 
treatment  the  pain  was  stopped  and  the  case  showed  marked  improvement. 

(7)  A  case  presented  spinal  lesion  in  the  form  of  a  too  great  anterior 
sweep  of  the  lumbar  region  of  the  spine. 

Spastic  Paraplegia  (Spastic  Spinal  Paralysis)  is  a  cord  disease  with 
loss  of  muscular  power,  exaggerated  patellar  reflexes,  a  peculiar  gait,  a:nd 
precipitate  micturition,     It  is  a  primary  lateral  sclerosis  of  the  cord. 

Case:  A  middle-aged  man,  after  injury  to  the  spine  in  a  mine  ac- 
cident, was  affected  with  complete  motor  and  sensory  paraplegia.  Opera- 
tion for  supposed  fracture  of  the  7th  dorsal  vertebra  removed  pressure  and 
restored  sensation  for  the  greater  part.  Spastic  paraplegia  developed.  The 
lesions  were  found  to  be  a  posterior  7th  dorsal  vertebra;  8th,  9th  a«d  l€^h 
posterior  and  toward  the  left.  Considerable  improvement  was  made  uftd«r 
treatment. 


190  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

Lesioxs  in  both  of  these  diseases  are  found  at  various  places  along  the 
spine.  In  spastic  paraplegia  they  are  generally  in  the  lower  dorsal,  lumbar 
and  sacral  regions. 

In  iocomotor  ataxia  spinal  curx'aiure  is  often  found  as  the  cause.  De- 
rangement of  the  thoracic  vertebrae  in  the  region  between  the  shoulders 
often  causes  it.     Atlas.  cer\-ical  and  lumbar  lesions  are  often  found. 

The  Progxosis  in  neither  disease  is  promising  as  to  cure.  Most  cases 
are  benefitted,  some  to  a  marked  extent.  Locomotor  ataxia  is  more  fre- 
'  quently  met  with  and.  on  the  whole,  more  successfully  treated.  The  pro- 
gress of  the  disease  is  often  checked:  the  lightning  pains  and  visceral  crises 
are  prevented  or  checked;  control  of  bladder  and  rectum  are  established; 
the  power  of  walking.  e%-en  afier  complete  loss  in  some  cases,  is  restored. 
These  cases  are  generally  benefitted,  but  sometimes  do  not  yield  to  treat- 
ment. In  cases  of  spastic  paraplegia  the  sum-total  of  results  is  not  so 
great.  The  walking  is  often  improved,  and  precipitate  micturition  is  bet- 
tered. 

The  sclerotic  changes  in  the  cord  in  these  diseases  renders  them  in- 
curable, even  after  removal  of  specific  lesion,  yet  the  sclerotic  process  is 
doubtless  often  checked  by  the  removal  of  lesion  and  the  attendant  treat- 
ment. 

A  few  cases  of  both  diseases,  in  early  stages  and  resulting  from  injur}*, 
are  reported  cured. 

The  TRE.ATMENT  of  locomotor  ataxia  consists  in  the  removal  of  lesion 
and  general  spinal  treatment.  The  removal  of  lesion  alone  is  insufficient. 
The  thorough  spinal  treatment  must  be  made  to  influence  spinal  ner\'e  con- 
nections.the  central  distrubution  of  the  sympathetics.and  the  blood -circula- 
tion about  and  to  the  spine.  This  treatment  should  be  given  esi>ecially 
from  the  middle  dorsal  down,  as  the  degenerative  changes  in  cord  and 
meninges  begin  in  the  lower  part.  If  the  ataxic  condition  has  not  yet  ap- 
peared in  the  arms,  and  cerebral  symptoms  have  not  developed  the  indica- 
tions is  especially  for  treatment  to  the  lower  spine.  Treatment  to  the 
upper  spinal  and  cervical  regions  should  be  given,  however,  at  any  stage,  to 
limit  or  prevent  the  spread  of  the  pathological  cord  changes  in  these  re- 
gions. 

The  nerve-supply  to  the  limbs,  upper  and  lower,  as  well   as   the   limbs 
tacmselves.   should   be  treated.     Care  must  be  taken  in  this  matter,  as  the 
tendency  of  the  long  bones  to  fracture  is  marked  in  locomotor  ata.xia.     The 
arthropathies,  if  present,   call   for  special  trealmeat  to  the  joint  involved, 
,    aad  its  nerve  and  blood-supply.     As  the  knee-joints  are  most  frequently  at- 
I  tacked,  the  treatment  tu  the  lower  limbs  will  ser\'e  to  lessen  the  danger  of 
r  t|ieir  opcurance.    The  spinal  treatment  should  include  springing  the  spine, 
.    and  various  other  methods  of  separating  the  vertebrae  from  each  other,  in- 
creasing circulation  about  them  and  keeping  up  their  nutritive   integrity,  as 
the  articular  surfaces  and  interarticular  fibro-cartilages  are  liable  respective- 
ly to  absorption  and  atrophy. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I91 

Abdominal  treatment  should  be  maintained  to  j)revent  visceral  crises, 
most  common  about  the  stomach.  Treatment  should  be  upon  the  abdom- 
inal nerve-plexuses  and  blood-circulation.  The  stomach  and  bowels  may 
thus  be  kept  in  good  condition.  Lumbar  and  sacral  treatment,  together 
with  treatment  to  the  internal  iliac  blood-vessels  from  the  abdominal  aspect, 
aid  in  restoring  the  spincters  of  bladder  and  rectum  to  good  conditions.  In 
case  of  necessity  a  catheter  should  be  used  to  empty  the  bladder.  To  re- 
lieve the  lightning  pains  in  the  limbs  strong  inhibition  should  be  made  up- 
on the  anterior  crural  nerve  in  Scarpa's  triangle;  upon  the  great  sciatic  at 
the  back  of  the  thigh  between  the  tuberosity  and  the  great  trochanter, 
slightly  nearer  the  latter;  and  upon  the  lumbar  and  sacral  portions  of  the 
spine. 

The  treatment  of  spastic  paraplegia  proceeds  upon  the  same  lines  as 
the  general  treatment  for  locomotor  ataxia,  including  removal  of  lesion, 
thorough  general  spinal  treatment,  and  treatment  of  the  lower  limbs.  The 
spasticity  in  the  latter  sometimes  hinders  treatment,  but  may  be  overcome 
by  inhibition  of  the  anterior  crural  and  sciatic  as  above. 

Other  forms,  such  as  Secondary  Spastic  Parahsis,  in  which  the  sym- 
ptoms are  not  so  well  marked;  Congenital  Spastic  Paraplegia,  usually  due 
to  injury  at  birth;  Ataxic  Paraplegia,  con::bining  spastic  and  ataxic  features 
retaining  the  reflexes;  and  the  Combined  S\'stem  Scleroses,  etc.,  arc  ap- 
proached in  the  same  manner  for  discovery  of  lesions  and  treatment. 


PARALYSIS  AGITANS. 
(Parkinson's  Disease.  Shaking  Palsy,) 

Definition: — A  chronic  disease,  in  which  there  is  tremor,  peculiar 
character  of  speech  and  gait,  and  progressive  loss  of  muscular  power. 

The  Lesions  found  in  this  disease  usually  occur  in  the  cervical  and  up- 
per dorsal  regions,  and  among  the  upper  ribs.  These  lesions,  being  pres- 
ent, doubtless  determine  the  victim  of  the  disease. 

It  occurs  in  those  whose  central  nervous  system  is  thus  weakened  and 
laid  liable  to  the  action  of  such  secondary  causes  as  exhausting  ilness,  men- 
tal strain,  worry,  traumatism,  etc.  The  latter  may  directly  result  in  such 
lesions.  The  fact  that  the  pathology  of  the  disease  is  obscure,  it  being  by 
many  regarded  as  a  functional  disturbance,  and  the  further  fact  that  the 
causes  are  not  well  known,  lends  color  to  the  theory  that  such  lesions  as 
are  recognized  by  Osteopathy,  being  alwa)'s  such  as  are  not  sought  for  by 
the  regular  practitioner,  are  the  real  causes  of  the  condition.  They  occur 
high  in  the  spine,  at  a  point  where,  acting  upon  the  central  nervous  sys- 
tem, they  could  produce  the  effect  in  the  whole  body,  as  noted  in  the 
tremor  of  both  upper  and  lower  limbs,  as  well  as  of  the  head  sometimes. 


192  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

The  Prognosis: — There  is  a  reasonable  expectation  of  limiting  the 
progress  of  the  disease  and  bettering  the  patient's  general  condition.  The 
fact  that  there  is  no  pathological  change  in  the  cord,  and  that  the  disease 
is  probably  functional,  leaves  ground  for  hope  that  very  much  benefit,  per- 
haps cure,  can  be  attained  under  osteopathic  treatment.  A  number  of  cases 
have  been  cured. 

The  practitioner  must  bear  in  mind  that  it  is  a  feature  of  the  disease 
for  the  patient  to  sometimes  be  better,  and  he  must  not  too  stronglj- encour- 
age the  patient  when  such  a  period  occurs,  without  reason  to  expect  the 
permanence  of  such  gain. 

The  Treatment  consists  in  removal  of  lesion;  the  thorough  relaxation 
of  all  spinal  and  cervical  muscles,  particular!}-  apt  to  be  set  and  hardened 
about  the  neck  and  shoulders;  and  a  most  thorough  general  spinal  treat- 
ment. Particular  attention  should  be  paid  to  the  condition  of  the  nerve- 
plexuses  supplying  the  upper  and  lower  limbs-  These,  and  the  circulation 
to  the  limbs,  should  be  strongly  stimulated.  The  general  health  is  usually 
good,  but  it  is  not  amiss  to  keep  bowels,  kidneys  and  liver  well  stimulated. 

Light  exercise  and  baths  are  good  for  the  case. 


OCCUPATION  NEUROSES. 

Definiiion:— A  neurosis  due  to  constant  use  of  certain  groups  of  mus- 
cles in  occupations  which  necessitate  delicate  movements,  resulting  in 
cramp,  spasm,  paralysis,  tremor  or  neuralgia,  and  due  to  specific  lesion  to 
the  nerves  supplying  the  affected  groups  of  muscles. 

The  very  numerous  varieties  of  this  disease,  various  forms  of  musician's 
cramp,  telegrapher's,  seamstress',  driver's,  milker's,  cigar-makers,  etc.,  are 
all  manifestations,  more  or  less  severe,  of  obstruction  to  the  nerves  supply- 
ing the  parts  involved.  These  obstructions  generall)'  act  upon  the  nerve- 
supply  of  the  upper  limbs,  but  in  a  few  varieties,  as  in  ballet-dancers  and 
tailors,  those  of  the  lower  limbs  may  be  involved. 

Cases: — Numerous  cases  of  telegrapher's,  writer's  and  piansit's  paral- 
ysis are  known  and  recalled  in  this  connection,  although  the  data  as  to  les- 
ions, etc.,  are  not  now  available.  These  cases  were  generally  cured.  The 
following  cases  are  typical. 

(i)     A  marked  case  of  telegVapher's  paralysis,  of  three  years'  standing. 

For  two  years  the  hands  had  been  almost  useless,  and  the  patient  could 
not  distinguish  by  touch  between  an  ink-stand  and  a  pencil,  sensation  and 
motion  were  both  much  impaired.  The  lesions  were  found  in  the  1st,  2d,  and 
3d  right  ribs  being  close  together;  the  clavicle  down  upon  the  right  first  rib 
and  the  cervical  origin  of  the  brachial  plexus  covered  with  much  contrac- 
ured  muscles.  After  one  month's  treatment  the  patient  could  write  his 
name.  In  six  weeks  he  could  distinguish  between  coins  by  touch,  and  in 
three  months  the  case  was  cured. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I93 

(2)  A  case  of  telegrapher's  paralysis  of  three  months'  standing.  The 
patient  had  stopped  work  to  go  to  a  hospital,  but  took  osteopathic  treat- 
ment instead.  In  three  days  he  was  able  to  return  to  work,  and  was  cured 
in  five  weeks. 

(3)  Pianist's  paralysis,  showing  lesions  in  the  upper  dorsal  spine. 

(4)  Pianist's  paralysis  showing  lesions  in  the  cervical  and  upper  dorsal 
regions  of  the  spine,  depression  of  both  clavicles,  and  contracture  of  mus- 
cles in  the  posterior  cervical,  upper  dorsal,  and  shoulder  regions. 

The  Lesions  in  these  cases  are  doubtless  often  directly  due  to  the  oc- 
cupation. Case  ( I )  above  is  a  good  illustration  of  the  result  of  an  occupa- 
tion requiring  the  elevation  of  the  right  shoulder,  resulted  in  drawing  to- 
gether the  upper  three  ribs,  and  in  approximating  the  clavicle  and  first  rib 
in  such  a  manner  as  to  bring  pressure  upon  the  brachial  plexus.  A  faulty 
posture,  involving  bad  position  of  the  shoulder,  neck  and  upper  spine,  is 
quite  as  likely  to  result  in  bony  lesions  in  these  parts  as  is  faulty  posture 
to  result  in  spinal  curvature. 

In  a  certain  number  of  cases  the  lesions  are  likely  present  in  the  spine 
and  other  parts,  and  determine  an  early  breakdown  in  the  anatomical  parts 
concerned  in  the  occupation,  from  over-use.  Over  use  of  an  arm,  as  in 
writing,  no  doubt  plays  its  part  in  wearing  out  the  nerve-mechanism,  but  the 
fact  that  many  young  people  suffering  from  an  occupation  neurosis  are 
found  to  have  these  lesions  while  many  other  persons  labor  assiduously  for 
years  at  the  same  occupations  without  disability,  indicates  that  the  lesions 
behind  the  excessive  use  is  the  real  cause  of  the  trouble.  Use  of  the  arm 
is  really  excessive  only  in  proportion  as  the  parts  do  not  recuperate  after 
use.  The  lesion  to  nerve-supply  prevents  proper  recuperation  and  the  arm 
wears  out  because  of  the  presence  of  lesion. 

In  pianists  spinal  disease  is  often  found  to  be  due  to  sitting  for  hours 
at  the  instrument.  It  may  as  reasonably  cause  spinal  lesions  of  a  nature  to 
result  in  the  neurosis  of  the  arms.  That  central,  i.  e.  spinal,  lesion  is  pres- 
ent is  indicated  by  the  fact  that  in  penmen  who  learn  to  write  with  the  left 
hand  after  an  attack  of  paralysis  in  the  right  the  disease  usually  soon  makes 
its  appearance  in  that  member  also.  In  pianists  the  trouble  is  generally 
bilateral  from  spinal  lesion. 

Lesions  may  occur  high  in  the  cervical  region,  but  such  is  not  likely  to 
be  the  case.  Lesions  from  the  origin  of  the  brachial  plexus  to  the  sixth 
dorsal  vertebra  are  met  with.  Most  commonly  the  lesion  lies  between  the 
5th  cervical  and  fourth  dorsal,  favoring  a  position  still  lower  in  the  cervical 
and  about  the  upper  three  or  four  dorsal.  Lesion  of  the  clavicle  and  upper 
two  ribs,  especially  upon  the  right  side,  are  very  common.  It  is  readily  seen 
from  the  nature  of  the  causes  producing  lesion  that  the  ribs  below  the  up- 
per two  may  be  involved.  Ribs  and  vertebrae  as  low  as  the  5th  or  6th  may 
be  luxated  and  cause  the  trouble.  Vaso-motor,  secretory  and  trophic  af- 
fections occur  in  the  affected  member.     Vaso-motors  to  the  arms  are  found 


194  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

as  low  as  the  first  thoracic  ganglion,  or  lower.  The  connection  of  the  inter- 
costal nerves  with  the  sNmpathetic  s}stem  may  explain  wh)-  rib  lesions  this 
low  may  cause  the  trouble.  The  first  and  second  intercostal  ner\es  are  con- 
nected with  the  brachial  plexus.  They  are  often  impinged  by~  the  corres- 
ponding ribs  in  these  troubles.  McConnell  calls  attention  to  the  fact  that 
slight  luxations  of  shoulder  and  elbow-joints  may  cause  this  disease.  In 
such  case  the  affect  would  probably  be  through  lesion  to  the  articular 
branches  supplied  from  the  brachial  plexus. 

While  Dana  states  that  this  condition  is  "a  neurosis  having  no  appre- 
ciable anatomical  basis,"  it  seems  from  the  results  gotten  b\-  the  removal  of 
lesion  that  Osteopath)-  discovers  the  real  anatomical  cause  of  disease. 

The  Prognosis  is  good.  Even  the  worst  cases  are  cured.  Cure  is  the 
rule,  though  some  cases  may  be  intractable. 

Treatment: — The  removal  of  lesion  as  the  direct  cause,  as  in  displace- 
ment of  the  clavicle  onto  the  brachial  plexus,  is  often  the  only  treatment 
necessar)'.  The  nerve  aud  blood-supply  of  the  affected  part  shouldjbe  kept 
free  by  treatment  upon  them  and  by  relaxation  of  all  contractured  muscles 
and  hardened  tissues.  The  arms  should  be  stretched  and  treated  as  de- 
scribed in  Chap.  X.  The  brachial  plexus  may  be  stimulated  on  the  inner 
side  of  the  arm  just  below  the  axilla,  and  in  the  neck  behind  the  clavicle. 
Treatment  should  be  carried  up  along  the  plexus  to  the  spine.  The  elbow 
and  shoulder  joints  should  be  sprung  and  adjusted  if  necessar)'.   (Chap.  X.) 

It  ma)-  be  necessary  to  have  the  patient  rest  from  his  occupation  dur- 
ing the  treatment,  particularly  at  first  for  a  few  weeks.  This  matter  depends 
upon  conditions.  Some  cases  have  been  cured  while  the  customary  work 
is  continued.  In  some  cases  it  is  well  to  give  a  general  treatment  to  the 
nervous  system,  as  nervous  symptoms  may  appear.  \'ertigo  and  insomnia 
are  sometimes  present,  doubtless  due  to  the  upper  spinal  lesions  affecting 
the  blood-circulation  to  the  brain. 

Local  work  should  be  carried  over  the  brachial  artery,  and  over  the 
fore-arm  and  hand.  This  increases  local  circulation  and  does  away  with 
the  local  congestion  and  secretory  disturbance  found  in  the  affected  mem- 
bers. It  may  be  useful  for  the  patient  to  develop  the  arms  by  systematic 
gymnastics.  The  various  mechanical  appliances  used  to  lessen  the  work 
upon  the  affected  muscle  groups  and  to  call  into  play  other  and  larger 
groups,  may  be  useful  if  the  patient  finds  it  necessary  to  continue  his  occu- 
pation. Sleeves  that  interfere  with  free  motion  of  the  hand  in  writing,  cuffs 
that  bind  the  wrist,  constricting  bands  that  ma)-  be  used  as  sleeve  support- 
ers, and  any  agency  limiting  motion  and  circulation  must  be  avoided. 

The  pain  frequentl)-  present  in  arms  and  shoulders  may  be  quieted  by 
inhibition  of  the  plexus  and  its  spinal  origin,  but  generally  yields  to  the 
general  process  of  relaxing  muscles,  etc. 


PRACTICE  AND  APPLIKD  THERAPEUTICS  OF  OSTEOPATHY.  I95 


NEURASTHENIA. 

(nervous  PROSTRATION.) 

Definition  :  "A  functional  disease  of  the  nervous  system,  character- 
ized by  mental  and  bodily  weakness."  It  is  not  a  psychosis.  There  is 
functional  exhaustion  and  irritablity  of  the  nerve  centers. 

Cases  :  (i)  Well  marked  neurasthenia  in  a  child  of  five,  a  neurotic. 
It  had  never  walked,  and  had  never  slept  in  the  daytime.  In  one  month  it 
became  able  to  walk  under  the  treatment. 

(2)  In  a  lady  a  case  of  three  years'  standing,  with  attendant  consti- 
pation, was  cured  in  two  months. 

(3)  In  a  woman  of  thirty-two,  neurasthenia  developed  after  confine- 
ment and  sickness.  Sjmptoms  of  the  disease  were  all  very  well  marked. 
Lesions  were  found  in  a  displacement  of  the  third  cervical  vertebra  to  the 
right,  general  depression  of  the  ribs,  separation  of  the  nth  and  12th  dorsal 
vertebrae,  a  posterior  luxation  of  the  fifth  lumbar  vertebra,  and  contracture 
of  the  lumbar  muscles.  The  neurasthenia  was  apparently  reflex  from  uter- 
ine disease.  Two  weeks'  daily  treatment  re-established  menstruation, 
which  had  been  suppressed  for  some  time.  Under  one  month's  treatment 
all  the  s)'mptoms  had  disappeared. 

(4)  A  case  of  neurasthenia  in  a  lady  of  sixty,  following  overwork  and 
runaway  accident.  The  whole  spine  and  body  was  hyperesthetic,  the  spinal 
tissues,  from  occiput  to  sacrum,  were  exceedingly  tense.  Treatment  was 
beneficial  from  the  first.  One  year's  treatment  produced  great  improve- 
ment. 

(5)  In  a  lady  of  fifty,  with  uterine  disease,  lesions  were  found  in  a 
posterior  luxation  of  the  atlas  and  depression  of  all  the  ribs,  narrowing  the 
thorax.     The  patient  was  benefitted. 

(6)  Neurasthenia  in  a  lady  of  thirty-five,  complicated  with  constipa- 
tion, ovarian  disease,  and  many  other  symptoms,  was  almost  cured  in  one 
month's  treatment. 

(7)  In  neurasthenia  of  eight  year's  standing,  due  to  cigarette  smoking, 
six  weeks'  treatment  cured  the  cigarette  habit  and  materiall)-  bettered  the 
general  condition. 

(8)  Neurasthenia  and  exophthalmic  goitre  of  one  month's  standing. 
The  goitre  was  cured  in  two  week's  treatment.  In  one  month's  treatment 
the  neurasthenia  was  cured  and  the  patient  had  gained  twent\-  pounds. 

(9)  Traumatic  neurasthenia  developed  after  the  patient  was  thrown 
from  a  buggy.  Lesion  was  found  in  a  slip  at  the  fourth  lumbar  and  marked 
lateral  luxation  of  the  tenth  dorsal  vertebra.  The  spinal  lesion  was  cor- 
rected in  three  weeks,  but  no  improvement  occurred  in  the  patient's  gener- 
al condition  until  ten  weeks'  treatment  had  been  taken.  After  two  weeks' 
further  treatment  the  case  was  well. 


196  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

(10)  In  a  man  of  thirt\-  neurasthenia  of  three  jear's  standing  was 
cured  in  two  months. 

(11)  In  a  young  lady  a  case  of  several  month's  standing"was  cured  in 
four  months. 

The  Lesio.ns  found  in  neurasthenia  are  general  spinal  lesions.  Differ- 
ent cases  present  different  lesions,  and  no  typical  lesion  may  be  described 
for  all  cases.  \'et  perhaps  a  majority  of  these  cases  show  a  depression  of 
all  of  the  ribs,  narrowing  the  thora.x  and  often  causing  enteropsis.  Float- 
ing kidney  and  enteroptosis  are  well  known  as  causes  of  neurasthenia. 
There  is  no  doubt  that  many  cases  of  neurasthenia  apparentl)'  thus  caused 
are  really  due  to  bad  spinal  condition  and  flattening  of  the  thorax  through 
depresssion  of  all  the  ribs.  These  extensive  lesions  effect  the  cerebro  spi- 
nal SNstem  directly,  also  the  s)'mpathetic  system,  thus  causing  the  neuras- 
thenia and  the  enteroptosis,  (p.  98.) 

Often  the  lesion  in  these  cases  is  such  as  produce  disease  in  some 
organ,  secondary  to  which  neurasthenia  is  developed.  This  is  well  illustra- 
ted in  these  lower  spinal  lesions  producing  uterine  disease,  from  which 
neurasthenia  is  reflexl\-  caused.  Thus  a  varietN'  of  lesions  may  be  found  in 
neurasthenia,  different  cases  presenting  different  lesions.  Each  case  de- 
mands an  individual  study.  For  the  production  of  neurasthenia  there  is 
necessary  merely  a  lesion  producing  an  irritation  upon  the  nerve  system, 
reflexl)-  or  directly,  allowing  a  leakage  of  nerve-force,  and  determining  the 
victim  of  neurasthenia  from  overwork,  worry,  uterine  disease,  naso-pharyn- 
geal  disease,  the  use  of  coffee,  alcohol,  etc. 

The  different  varieties  of  neurrasthenia  ma)'  be  caused  by  the  predom- 
inance of  lesion,  e.  g.,  the  cerebral  t>  pe  by  upper  dorsal  and  cer\ical  le- 
sions, the  gastric  by  splanchnic  lesions,  the  lithemic  by  lower  dorsal  and 
upper  lumbar  lesions,  etc.  lefluenza,  a  common  cause  of  this  disease,  is  a 
malad\-  pariicularl)-  noted  by  osteopathy  as  producing  serious  spinal  lesions, 
mostly  in  the  shape  of  contractured  muscles  and  tenseness  of  the  other 
tissues,  but  sometimes  actual  bony  lesions  by  drawing  parts  out  of  place 
through  contracture  of  attached  tissues.  Lesions  thus  produced  may 
cause  neurasthenia.  Neurasthenia  is  common  as  the  result  of  traumatism, 
such  as  caused  by  railway  accidents,  bon)'  lesions  thus  being  produced  as 
irritants  to  nerves. 

The  Prognosis  for  cure  is  good.  Those  cases  that  have  not  \  ielded  to 
an)'  of  the  usual  modes  of  treatment  often  readily  yield  to  osteopathic 
treatment.  The  best  of  results  may  be  expected  in  the  worst  cases.  Cases 
are  often  quickly  cured  f  gotten  in  the  early  stages.  The  average  case 
demands  a  somewhat  long  course  of  treatment,  varying  from  a  few  months 
to  a  year  or  more. 

The  Treatment  must  be  adapted  to  the  case  in  hand  after  a  special 
study  of  its  peculiarities  and  requirements.  The  removal  of  every  source 
of  reflex  irritation  is  necessary,  but  these  sources  must    be    studied    out    in 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I97 

«ach  individual  case.  The  lesions  present  should  be  removed,  but  the  case 
is  not  always  at  once  benefitted  thereby,  as  a  course  of  treatment  is  gener- 
ally necessary  to  recuperate  the  exhausted  nerve-centers.  Consequently  a 
most  systematic  and  thorough  course  of  treatment  be  devoted  to  this  end. 
The  various  spinal  treatments  as  described,  for  relaxation  of  all  spinal 
tissues,  springing  the  vertebrae  apart  for  freedom  of  circulation  and  stimu- 
lation of  the  spinal  nerve-system  and  the  circulation  thereto,  is  given  to 
increase  nutrition  of  the  nervous  system  and  upbuild  the  exhausted  centers. 
This  spinal  treatment  affects  the  sympathetic  system  markedly.  Cervical 
treatment  is  also  important  in  this  connection.  Good  results  are  usually 
at  once  apparent  in  relief  of  nerve-tension,  reduction  of  irritabilit}-,  and 
correction  of  function. 

Special  manifestations  of  the  condition,  as  headache,  insomnia,  vertigo, 
etc.,  call  for  cervical  treatment  particularly.  Bowels,  kidneys,  liver,  etc., 
must  be  carefully  looked  after  to  relieve  the  constipation,  lithemia,  anorexia 
and  other  such  symptoms  usually  present.  A  thorough  general  treatment 
•of  the  whole  body  is  not  amiss  in  these  cases. 

The  patient  must  be  kept  free  from  excitement  and  from  all  causes  ot 
drain  upon  nervous  vitality.  The  diet  should  be  light  and  nutritious.  The 
use  of  cold  sponge  or  shower  baths  may  be  helpful.  Advising  the  patient 
to  take  gentle  exercise,  baths,  etc,,  will  aid  him  to  preserve  a  cheerful  state 
of  mind.  Some  cases  may  be  treated  daily  with  advantage,  in  the  begin- 
ning of  the  treatment.  Later,  the  treatments  may  be  decreased  in  number 
to  three  or  two  per  week. 


HYSTERIA. 

This  is  a  condition  frequently  met  and  treated  osteopathically.  One 
needs  to  be  continually  upon  guard  against  its  simulation  of  other  condi- 
tions, being  equally  careful  not  to  overlook  other  diseases  because  of  a  hur- 
ried diagnosis  of  hysteria.  Being  a  functional  disease  of  the  nervous  sys- 
tem, and  a  psxxhosis,  it  is  frequently  found  to  depend  upon  some  spinal 
bony  lesion  acting  as  the  cause  disturbing  the  nervous  equilibrium.  The 
lesion  varies.  One  cannot  expect  a  certain  kind  of  lesion  in  these  cases, 
but  generally  finds  some  actual  derangement  which  is  at  bottom,  responsible 
for  the  altered  nerve-conditions  making  it  possible  for  a  neurotic  disposi- 
tion, infectious  fevers,  poisons  of  various  kinds,  emotional  disturbances, 
mental  or  physical  strain,  and  other  causes  to  result    in    hysterical    attacks. 

Correction  of  lesion  removes  the  primary  cause  of  irritation  to  the 
nervous  system,  perhaps  cures  a  certain  disease  to  which  the  hysteria  is 
secondary,  and  is  an  important  step  in  the  radical  cure  of  the  condition. 

The  Prognosis  for  cure  is  good.  The  treatment  relieves  nervous  ten- 
sion and  quiets  the  overwrought  system  at  once. 


198  PRACTICE   AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

In  the  7>rrt/;//d';// considerable  tact  must  be  used.  The  primary  treat- 
ment embraces  the  removal  of  all  lesions  and  causes  of  irritation.  A 
course  of  treatment  for  the  general  nervous  system  must  be  carried  through. 
The  general  treatment  as  described  for  upbuilding  the  nervous  system  in 
neurasthenia  would  be  applicable  here. 

During  an  hysterical  attack  the  practitioner  must  use  great  firmness, 
but  not  violence,  with  the  patient.  He  must  gain  mental  and  moral  con- 
trol, and  while  appljing  a  general  relaxing  and  inhibitive  spinal  and  cervi- 
cal treatment  to  relieve  nerve-tension  and  to  quiet  the  nervous  s>'stem,  b)-  a 
strong  show  of  authorit)-  compel  the  patient  to  cease  various  motions,  un- 
bend a  clinched  hand,  stop  incoherent  talking,  etc  Sometimes  a  dash  of 
cold  water  upon  the  face  or  abdomen,  or  pressure  over  the  ovaries  will  end 
the  attack.  All  sympathetic  friends  must  be  dismissed  from  the  room,  and 
moral  suasion,  with  isolation  of  the  patient,  be  tried.  The  practitioner 
must  gain  the  patient's  confidence.  Hysterical  joints,  h)'sterical  pains, 
contractures,  eye-symptoms,  paralyses,  etc.,  call  for  no  special  treatment; 
all  disappear  upon  regulation  of  the  mental  condition  and  upbuilding  of 
the  general  nervous  system. 

Many  chronic  cases,  as  in  bed-ridden  hysterics,  must  be  carried  through 
a  course  of  education  in  performing  simple  motions  and  acts  which  they 
thought  beyond  their  power.  The  patient  should  lead  a  regular  lite,  and 
her  mind  should  be  kept  occupied  by  some  engrossing  occupation. 

Judicious  management  of  the  case,  authority  over  the  patient,  and  a 
careful  general  course  of  treatment  for  the  health  of  the  body  and  partic- 
ularly of  the  nervous  s\'stem,  will  be  successful  in  the  majority    of  cases. 


INSOMNIA. 

Definition:  Incomplete,  disturbed,  or  lacking  sleep.  A  condition 
frequently  idiopathic  and  caused  by  specific  lesions,  usually  bonj-.  Idiopa- 
thic insomnia  embraces  man}-  forms  generally  looked  upon  as  s)'mptomatic 
or  secondary.  Many  reall}-  symptomatic  or  secondary  cases  are  noted,  es- 
pecially in  nervous  diseases,  the  primary  condition  itself  being  usually 
found  to  depend,  at  bottom,  upon  bon\-  lesion. 

Cases:  Ver)- numerous  cases  are  met  and  treated  osteopathically.  The 
following  cases  illustrate  various  points  in  connection  with  such  cases: 

(i)  Insomnia,  nervousness,  and  a  complication  of  troubles.  Sleep 
could  not  be  induced  by  the  most  powerful  soporifics.  Lesion  was  found 
among  the  cervical  and  upper  dorsal  vertebrae.  The  case  was  cured  in  two 
months'  treatment. 

(2)  Insomnia  and  general  nervousness,  pronounced  incurable.  The 
patient    had    had    no   good    nights'    sleep    in  five  years,  and  had  become  a 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  I99 

nervous  wreck.     Lesion  was  found  in  the  shape  of  contractured  condition  of 
all  the  cervical  muscles.     The  case  was  cured  in  one  month. 

(3)  A  case  of  several  years'  standing,  in  which  the  lesion  affected  the 
atlas,  which  was  displaced  a  little  to  the  right,  was  cured  by  the  correction 
of  the  lesion  in  six  treatments. 

(4)  A  case  of  insomnia  as  an  accompaniment  of  neurasthenia,  in  which 
the  patient  had  depended  upon  soporifics  for  a  number  of  years,  slept  welt 
after  the  second  or  third  treatment.  The  use  of  artificial  aid  to  sleep  was 
necessary  but  at  rare  intervals  thereafter.  The  case  was  practically  cured 
at  the  time  of  report. 

(5)  A  case  of  insomnia  of  some  years'  standing,  due  to  cervical  and 
upper  dorsal  lesions,  cured  in  six  months'  treatment. 

(6)  A  case  of  three  years'  standing,  in  which  the  heart-beat  had  be- 
come very  irregular  from  the  resulting  nervousness.  Four  treatments  cor- 
rected the  heart-beat,  and  the  case  had  been  practically  cured,  at  the  time 
of  report,  by  two  months'  treatment. 

(7)  A  case  of  paroxysmal  sleep,  or  narcolepsy,  presenting  lesion  in  the 
form  of  a  luxation  of  the  second  cervical  vertebra  toward  the  right.  The 
case  was  not  observed  under  treatment. 

(8)  A  case  of  narcolepsy  due  to  cervical  lesions  successfully   treated. 
Lesions  and  Anatomical  Relations:     The  lesions,  both  in    insomnia 

and  in  the  various  other  disorders  of  sleep,  are  generally  found  in  the  atlas 
and  cervical  and  upper  dorsal  regions.  All  such  cases,  perhaps  constitut- 
ing a  majority  of  all  cases  of  these  diseases,  should  be  regarded  from  the 
osteopathic  point  of  view  as  idiopathic  insomnia,  dependent  upon  speci- 
fic lesion  interfering  with  circulation  to  the  brain.  Lesions  to  the  atlas  and 
second  cervical  vertebra  are  very  common  causes,  and  lesions  usually  occur 
within  the  cervical  region  or  among  the  upper  five  dorsal  vertebrae.  Le- 
sions to  clavicle  and  to  corresponding  ribs  may  be  present.  It  will  be  ob- 
served that  from  the  occipui^t  to  5th  dorsal  all  these  lesions  fall  within  a 
area  particularly  rich  in  sympathetic  and  vaso-motor  centers  for  the  head, 
as  before  pointed  out.  Atlas  and  axis  lesion  acting  upon  the  superior  cer- 
vical ganglion,  medulla,  or  curvical  sympathetic,  and  other  cervical  and  the 
upper  dorsal  lesions  acting  upon  the  sympathetic  nerves  supplying  vaso- 
motor control  to  the  blood  vessels  of  neck  and  head,  disturb  circulation  to 
the  brain  and  cause  the  insomnia.  Direct  pressure  of  the  cervical  vertebrae 
upon  the  vertebral  arteries  may  contribute^to  ,or  produce,  the  same  result. 

It  is  probable  that  in  many  cases  of  insomnia  there  is  an  anemic  state 
of  the  brain  caused  by  the  interference  of  such  lesions  with  the  sympathet- 
ics  or  by  direct  pressure  upon  the  arteries.  The  insomnia  in  various  dis- 
eases of  the  heart  and  arteries,  in  general  anemia,  and  in  Bright's  disease,  is 
said  to  be  due  to  an  anemic  condition  of  the  brain.  On  the  other  hand  it 
is  doubtless  true  that  there  is  in  many  cases  a  sluggish  or  impeded  cere- 
bral circulation  as  a  result  of  the  disturbance  of  sympathetic  vaso-motors,, 


200  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

impeded  venous  return,  etc.,  caused  by  these  lesions.  In  neurasthenic  in- 
somnia, it  is  said,  there  is  loss  of  vaso-motor  tone  in  the  cerebral  vessels. 
The  use  of  various  mechanical  remedies  is  based  upon  the  idea  of  calling 
the  blood  from  the  head  to  the  skin  or  abdominal  organs,  e.  g.,  a  hot  foot- 
bath, eating  a  light  lunch,  etc. 

In  some  cases  the  symptoms  indicate  the  necessity  of  increasing  or  de- 
creasing the  amount  of  blood  in  the  cerebral  vessels,  and  these  results  may 
be  readily  attained  by  the  appropriate  treatment.  But,  from  the  nature  of 
the  case,  removal  of  lesion  and  the  restoration  of  free  circulation  result  in 
restoring  normal  quiet  to  the  nerve  mechanism  and  normal  flow  of  the 
blood  in  the  vessels,  characteristic  of  the  normal  bod)'  which  enjoys  health- 
ful sleep.     .Such  a  result  is  the  most  rational  object  of  the  treatment. 

When  insomnia  is  symptomatic  or  secondary,  lesions  must  be  sought 
according  to  the  primary  condition. 

In  some  cases  of  disturbed  vaso-motor  conditions  of  the  brain,  lesion  is 
found  in  the  form  of  much  thickened,  tensed,  and  overgrown  tissues  at  the 
base  of  the  skull,  above  and  about  the  spine  of  the  axis,  extending  laterall}' 
toward  the  mastoid  process.  With  this  condition  there  frequentl)'  exists 
an  approximation  of  the  second  cervical  spine  to  the  occiput. 

The  Prognosis  in  insomnia  is  good.  No  class  of  cases  presents  more 
striking  results  in  the  shape  of  cure  of  the  most  long-standing  and  intract- 
able cases.  It  is  a  frequent  occurrence  that  a  case  of  some  year's  standing 
is  made  to  sleep  natural!)-  after  a  single  or  few  treatments. 

Not  all  cases  thus  easily  yield  to  treatment.  Often  great  patience  and 
persistence  are  necessar)'  to  secure  good  results. 

The  Treatment  calls  for  the  removal  of  lesion  primarily,  and  of  any 
cause  of  irritation  to  the  nervous  system.  The  treatment  as  described  in 
detail  for  headache,  q.  v.,  is  applicable  here.  It  embraces  inhibition  of  the 
superior  cervical  ganglion  and  of  all  the  cervical  vaso-motors,  including  the 
middle  and  inferior  cervica;l  ganglion  and  the  upper  dorsal  centers,  deep 
pressure  beneath  the  ears  and  beneath  the  occiput  (p.  187.)  All  the  cervi- 
cal muscles  and  other  tissues  should  be  thoroughly  relaxed.  A  general 
spinal  treatment,  in  nervous  cases,  at  once  relieves  nerve-tension  and  irrita- 
tion, and  materiall)-  aids  in  producing  sleep.  It  is  sometimes  well  to  add 
to  this  a  general  body  treatment  as  an  aid  in  equalizing  circulation  and 
toning  up  the  nervous  s)-stem.  All  points  of  cervical  circulation  [should  be 
attended  to.  The  treatment  begun  over  forehead  and  face  may  be  contin- 
ued down  over  the  neck,  opening  the  mouth  against  resistance,  stimulating 
the  carotid  arteries  and  jugular  veins,  raising  the  clavicles,  and  even  the 
upper  few  ribs,  and  thus  entirely  freeing  the  circulation  to  and  from  the 
head. 

In  cases  of  congestion  of  the  cerebral  vessels  the  inhibitive  abdominal 
treatment  should  be  used  to  draw  the  blood  away  from  the  head  to  the  ab- 
dominal vessels. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  201 

In  anemic  cases  one  should  add  treatnneni  to  liver,  kidneys,  stomach, 
bowels  and  spleen.  The  heart  and  lungs  should  be  stimulated.  In  insom- 
nia due  to  auto-intoxication,  as  in  lithemia,  uremia,  malaria,  etc.,  one 
should  look  particularly  to  the  excretions.  Various  domestic  remedies 
may  prove  useful  in  simple  cases,  such  as  a  warm  general  bath,  a  hot  foot- 
bath, a  cold  douche  down  the  spine,  exercise  and  light  massage,  sleeping  in 
cold  rooms,  avoidance  of  late  meals,  and  the  avoidance  of  mental  work 
several  hours  before  retiring. 

The  various  perversions  of  sleep,  such  as  dreams  and  nightmare,  som- 
molentia,  or  incomplete  sleep,  sommambulism,  morbid  drowsiness,  narco- 
lepsy, catalepsy  and  prolonged  sleep,  would  all  be  approached  and  treated 
upon  the  same  lines  as  laid  down  for  insomnia. 


PRACTICE  ANDAPPLIED  THERAPEUTICS  OF  OSTEOPATHS.  2O5 


PARALYSIS, 

The  various  forms  of  paralysis  come,  with  much  frequency,  under  oste- 
opathic treatment.  Paralysis  of  every  part  of  the  body,  and  from  various 
causes,  is  successfully  treated.     The  following  cases  are  illustrative. 

Cases:— (r)  Paraplegia  in  a  young  lady,  caused  by  fall  of  eighteen  feet. 
The  lower  half  of  the  body,  aud  the  lower  limbs  were  paralyzed;  control  of 
the  bladder  was  lost;  within  a  certain  period  of  five  months  she  had  passed 
twenty-eight  calculi  about  the  size  of  peas,  never  before  the  accident  hav- 
ing had  any  urinary  trouble.  Lesions  as  follows:  Marked  posterior  and 
slight  lateral  curvature  of  the  spine,  involving  the  lov\er  and  upper  lumbar 
regions;  the  coccyx  was  bent  and  twisted;  the  right  innominate  bone  was 
luxated  backward.  The  condition  was  of  nine  and  one-haif  months  stand- 
ing. After  the  first  treatment  she  was  able  to  sleep  without  the  customary 
opiate.  During  the  second  week's  treatment  she  began  to  gain  control  of 
the  bladder;  and  the  bowels  acted  naturally.  The  urine  became  normal  at 
this  time.  Durmg  the  course  of  the  treatment  an  ulcer  upon  the  right 
foot  healed.  A  course  of  two  month's  treatment  had  almost  cuied  the  pa- 
tient at    the    time  of  reporting  the  case. 

(2)  Paraplegia  in  a  man,  due  to  an  injury  in  a  runaway  accident  in 
which  he  was  thrown,  striking  the  lower  dorsal  and  lumbar  regions  of  the 
spine.  After  two  weeks  he  gradually  began  to  lose  the  use  of  his  limbs, 
and  in  seven  months  he  was  confined  to  a  chair,  soon  becoming  unable  to 
move  a  muscle  of  either  limb.  Lesions  were  as  follows:  gth,  loth  and  i  ith 
dorsal  vertebrae  displaced  backward  sufficientl)'  to  simulate  the  posterior 
angular  projection  in  Potts'  disease;  a  marked  contraction  of  the  muscles  of 
the  right  side  of  the  spine  from  the  ninth  dorsal  down;  slight  swerving  of 
the  spine  to  the  same  side  as  the  contracture  and  limited  by  its  extent; 
great  tension  and  slight  lesion  at  the  junction  of  the  fifth  lumbar  vertebra 
with  the  sacrum;  a  binding  together  of  all  the  spinal  vertebrae  by  an  appar- 
ent contracture  of  the  ligaments.  After  a  few  treatments  motion  returned, 
and  the  patient  was  able  to  go  about  upon  crutches.  The  case  had  been 
almost  cured  after  a  course  of  five  weeks' treatment, 

(3)  Complete  paralysis  of  the  body  below  the  waist,  and  of  the  lower 
limbs,  caused  by  spinal  curvature.  The  case  was  entirely  cured,  sensa  tion, 
motion,  and  function  of  a'odominal  and  pelvic  organs  being  restored, 

(4)  Lack  of  free  use  of  the  feet  due  to  a  paralytic  stroke  six  years  be- 
fore. A  disarticulation  among  the  tarsal  bones  was  discovered,  and  its  re- 
moval practically  cured  the  case. 

(5)  Monoplegia,  partial  in  one  lower  limb,  of  a  number  of  years'  stand- 
ing was  cured  by  the  treatment. 

(6)  Paraplegia,  partial,  was  cured  by  correction  of  lesion  of  the  sixth 
dorsal  vertebrae. 


206  PRACTICE  AND  Ari'LIED  THERAPEUTICS  OF  OSTEOPATHY. 

(7)  General  paralysis  in  a  casr  which  gradually  for  six  )ears  lost  the 
use  of  all  the  voluntar)'  muscles,  the  eyes  were  crossed  and  nearly  blind, 
bowels  and  bladder  were  involved.  The  case  was  cured  by  adjusting  lesion 
between  the  atlas  and  occuput,  the  latter  being  displaced  anteriorly  upon  the 
former. 

(S)  Infantile  paralysis  invohing  the  left  lower  limb.  The  case  was 
in  a  child  two  }ears  old.  A  sacro-iliac  lesion  was  found  as  the  cause, 
and  was  treated.  The  child  could  move  the  limb  slightl)' after  the  first 
treatment,  and  after  the  si.xth  treatment  perfect  use  was  restored. 

(9)  A  case  of  paralysis  was  found  presenting  lesions  at  the  occipito- 
athintal  and  lunibo-sacral  articulations,  and  from  the  sixth  to  the  tenth 
dorsal  vertebrae.  There  was  a  history  of  exposure,  alcoholism,  sexual  ex- 
cess and  great  physical  strain.  Correction  of  the  lesions  effected  a  cure  in 
five  months. 

(10)  A  case  of  paraplegia  in  a  man  of  fifty-fi\e,  due  to  injury  in  a  rail- 
road wreck.  Both  innominate  bones  were  found  displaced  anteriorl)',  and 
lesions  were  found  involving  the  whole  lumbar  and  lower  dorsal  regions  of 
the  spine.  The  paralysis  of  the  limbs  was  total.  After  three  treatments 
the  patient  could  walk  with  crutches.  After  two  weeks  treatment  the  pa- 
tient could  walk  without  crutch  or  cane,  being  as  well  as  ever,  excepting 
some  weakness  of  the  spine. 

(11)  Paraplegia,  involving  the  bowels,  in  a  lad\-  of  fift)--three,  and  of 
fifteen  years'  standing.  Sensation  was  lacking  in  the  limbs,  and  there  was 
very  little  motion.  In  less  than  one  month's  treatment  sensation  and  mo- 
tion were  both  perfectl}'  restored  and  the  bowels  were  acting  naturally. 

(12)  Hemiplegia  of  the  left  side  following  two  strokes,  one  fifteen 
years  previously,  one  four  )ears.     The  j)atient  was  cured  in  one  month. 

(13)  Taralwsis  following  a  stroJ<e.  The  cervical  muscles  u'ere  found 
contractured.  Their  correction  was  accomplished  in  five  weeks,  and  none 
of  the  paral\tic  condition  remained. 

(14)  Paralysis  affecting  the  fingers  and  thumbs  of  both  hands  in  a  boy 
of  fourteen.  The  only  lesion  was  contracture  of  the  muscles  along  the 
lower  cervical  and  upper  dorsal  regions  of  the  spine.  There  was  also  some 
atiophyofthe  muscles  over  the  brachial  plexus  and  the  axillarv- artery. 
Five  months'  treatment  restored  the  thumbs  and  first  two  fingers  to  nearly 
normal  condition,  the  condition  of  the  other  fingers  was  much  improved, 
and  the  hands  could  be  used  considerably. 

(15)  ParalNsis  and  muscular  atroph)-  of  both  arms  in  a  boy  six  years 
of  age.  The  condition  followed  an  attack  of  malaria.  The  condition  spread 
to  involve  both  lower  limbs.  Spinal  lesions  were  found  preventing  circu- 
lation to  the  cord.  The  child  began  at  once  to  improve  under  the  treat- 
ment. After  the  third  treatment  he  could  move  his  fingers.  In  two  weeks 
he  could  use  his  hands  well  enough  to  feed  himself.  In  one  month  he  was 
practically  cured. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  20/ 

(i6)  Disseminated  subacute  cer\'ical  and  lumbar  m)-elitis  in  a  boy  of 
seven,  following  the  swallowing  of  two  pins.  Severe  illness  at  once  fol- 
lowed, and  in  the  fifth  week  the  pins  were  located  by  the  X-ray  on  the  left 
side  about  the  level  of  the  third  cervical  vertebra.  They  were  later 
ejected,  he  becoming  immediately  totall)'  paraljv.ed.  For  two  weeks  it  was 
thought  he  could  not  live.  After  about  seven  weeks  the  case  came  under 
osteopathic  treatment.  The  tissues  of  the  entire  cervical  region  were  badly 
swollen  and  intensely  painful,  and  this  condition  was  found  along  the  whole 
spine.  Control  of  the  bowels  and  bladder  was  lost,  and  the  muscles  of 
both  upper  and  lower  limbs  atrophied.  After  the  first  treatment  the  pa- 
tient slept  soundl)'  for  the  first  time  in  two  weeks.  After  about  four 
months'  treatment  the  case  was  practicall}-  cured.  ^ 

(17)  Monoplegia  attacking  the  right  lower  limb  of  a  girl  of  six^'para- 
lyzed  since  the  age  of  ten  as  the  result  of  spinal  meningitis.  No  bony  le- 
sion was  found,  but  the  treatment  was  directed  to  increasing  the  circulation 
to  the  cord.     The  case  was  practically  cured  in  three  months'  treatment. 

(18)  Paraplegia  in  a  girl  of  four,  which  had  been  gradually  develop- 
ing for  one  )'car,  showed  improvement  after  the  first  treatment  and  was 
cured  in  less  than  one  month. 

(ig)  Paraplegia  of  eight  months' standing.  The  patient  was  bedridden. 
Lesion  was  found  as  a  posterior  condition  of  all  the  lumbar  vertebrae  and  a 
slip  of  the  last  lumbar  upon  the  sacrum.  The  case  was  cured  in  three 
months. 

(20)  Bell's  disease  (facial  paralysis),  due  to  lesion  at  the  second  cervi- 
cal vertt  ora,  cured  in  three   weeks. 

(2t)  Partial  paral)^sis  of  the  lower  limbs  of  four  months'  standing,  due 
to  lesions  at  the  sacro-iliac  articulation  and  at  the  5th  dorsal  vertebra,  cured 
in  two  months. 

(22)  Partial  paral)-sis  in  a  lower  limb  in  a  girl  of  six,  since  infanc}', 
accompanied  by  under-developement  of  the  limb,  was  found  to  be  due  to  a 
partial  dislocation  of  the  hip,  and  was  cured  in  two  months. 

(23)  Paralysis,  probably  Progressive  Spinal  Muscular  Atroph\-,  in  a 
woman  of  thirty-flve,  of  fifteen  years'  standing.  The  last  two  years  had 
been  spent  in  bed.  Lesions  were  found  at  the  /t'h  curvical  and  1st  dorsal 
vertebrae,  which  were  anterior.     The  case  was  cured  in  ten  months'. 

(24)  Paralysis  of  the  fingers,  affecting  the  last  two,  and  partly  the 
middle  finger  of  the  right  hand.  The  patient  was  a  lady  of  seventy-nine 
years  of  age.  A  fall  upon  the  hand  had  occured  a  short  time  previously. 
A  slight  lateral  lesion  of  the  first  dorsal  vertebra  was  found  and  corrected, 
curing  the  case  in  six  weeks. 

(25)  Hemiparcsis  or  Hemiplegia  in  a  lady  of  sixty,  of  six  weeks'  stand- 
ing. The  right  side  was  affected.  Lesion  was  found  in  the  3rd  cervical 
and  5th  lumbar  vertebrae,  the  spinal  muscles  also  being  much  contracted. 
The  patient  walked  after  the  third  treatment  and  was  cured  in  six  weeks. 


2o8  PRACTICE  AND  APPLIED  THEKAPEUTJCS  OF  OSTEOPATH V. 

(26)  Hemiplegia,  alternate  or  crossed,  following  a  stroke  a  year  be- 
fore, affected  the  left  side  of  the  face  and  the  right  arm  and  lower  limb. 
Case  was  practically  cured  in  three  and  one-half  months'  treatment. 

{2/)  Hemiplegia,  partial,  of  the  right  side,  folloving  lightning-stroke. 
A  displacement  of  the  atlas  was  found  and  righted  at  once,  immediately 
curing    the    case. 

(28)  Paralysis  and  Dysentery.  The  paral)sis  affected  the  lower 
limbs,  and  had  been  of  seven  years'  standing.  Leaion  was  found  as  great 
tenderness  at  the  lumbo  sacral  joint,  a  slip  forward  of  the  5th  lumbar,  luxa- 
tion of  the  innominate?,  and  a  lateral  swerxe  of  the  lumbar  and  lower  dorsal 
region  of  the  spine-  A  tremor  of  the  head  was  present,  the  cervical  mus- 
cles being  very  tense.  After  seven  months'  treatment  the  lesion  were  about 
o\'crcome  and  the  patient  was  nearly  well. 

(29)  Paralysis  affecting  certain  muscles  of  the  throat,  also  affecting 
the  speech.  The  lesion  was  found  in  a  contracture  holding  the  hyoid  bone 
out  of  place.     The  patient  was  cured  by  relaxing  the  contracture. 

(30)  Facial  paral)si>  of  more  than  one  years'  standing,  was  cured  in 
three  weeks'  treatment.  The  lesion  was  found  in  a  displacement  of  the 
second  cervical  vertebra. 

(31)  Facial  paralysis  caused  by  luxation  of  the  atlas  and  axis  to  the 
left.  There  was  also  tension  of  the  tissues  at  the  base  of  the  skull  and  on 
the  left  side  of  ihe  neck.  The  case,  still  under  treatment,  was  improving 
satisfactorily. 

(32)  Facial  paralysis  was  seen  on  the  day  following  its  first  appear- 
ance. The  lesion  was  marked  muscular  contraction  at  the  angle  of  the  jaw 
on  the  affected  side  Treatment  gave  immediate  relief,  and  the  case  had 
almost  been  cured  in  ten   treatments. 

(33)  Progressive  paralysis  in  a  case  after  two  falls  causing  serious  ill- 
ness. Motion  in  the  lower  limbs  was  lost,  blindness  ensued,  and  speech  be- 
came unintelligible.  There  was  formication  in  the  hands  and  arms,  and  ex- 
treme pain  along  the  spine,  occuring  in  agonizing  paroxysms.  Lesions 
were  found  as  a  lateral  dislocation  of  the  third  cervical  vertebra,  luxation 
of  /th  and  8th  right  ribs,  and  a  posterior  piotrusion  of  the  lumbar  vertebrae 
One  treatment  brought  the  first  sleep  possible  in  three  days.  Under  treat- 
me  It  the  spinal  pain  was  relieved,  vision  was  restored,  and  the  patient  had 
been  practicall\-  cured  at  the  time  of  the  report. 

(34)  Crutch  paralysis  in  a  man  of  sixt}-five,  causing  loss  of  use  of  the 
left  hand.  A  crutch  had  been  used  on  the  left  side.  The  head  of  the 
second  left  rib  was  found  displaced,  and  the  head  of  the  humerus  was 
slightly  dislocated  anteriorly.  After  eleven  treatments  the  patient  was 
well. 

(35)  Myotonia  Congenita  (Thomsen'sDisease)  in  a  man,  of  ten  years' 
standing.     Lesion  of  a  lumbar  vertebra  was  removed,  curing  the  case. 

(36)  Hemiplegia  in  a  child  twenty  months  old,  of  ten    months  stand- 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  209 

ing.  Lesion  was  found  at  the  atlas,  which  was  immediately  replaced,  and 
rapid  improvement  followed.  In  three  weeks  the  child  could  walk,  and  re- 
co\'ery  was  almost  perfect. 

(37)  Brachial  Neuritis  of  five  months'  standing,  causing  severe  pain  in 
amrs  and  shoulders,  and  partial  paralysis  of  the  hands.  Lesions  were  found 
in  luxation  of  the  2nd,  3rd  and  4th  right  ribs,  and  the  2nd  left  rib,  with  ir- 
regularities of  the  lower  cervical  and  upper  dorsal  \'ertebrae.  One  treat- 
ment greatly  relieved  the  pain;  three  treatments  enabled  the  patient  to 
close  his  hands  and  snap  his  finders;  and  in  three  months'  treatment  the 
case  was  entirely   cured. 

(38)  Partial  paral)'sis  of  one  hand,  loss  of  memory,  and  at  times  in- 
ability to  articulate.  Lesion  was  found  at  the  2nd  cervical  \-ertebra.  The 
case  was  cured  by  one  month's  treatment. 

Lesions:  Thirty-two  of  the  abo\e  cases  reported  lesion.  Twenty- 
se\'en  of  the  thirt)'two  were  bony  lesions,  while  five  of  the  lesions  were  con- 
tractures as  the  sole  apparent  anatomical  derangements.  Twent)'-one  of 
the  bony  lesions  were  vertebral;  three  were  rib  lesions;  one  was  a  hip  lesion ; 
five  were  of  the  innominates;  one  of  the  cocc\x;  five  of  the  atlas.  In  but 
seven  was  there  serious  accident  as  the  obvious  circumstance  resulting  in 
such  injur}'  as  to  cause  the  paralysis.  Minor  accidents  were  doubtless  the 
causes  of  many  of  these  lesions.  Thirty-five  of  the  thirt\'eight  cases  re- 
ported were  reported  as  cured.  In  twenty-eight  of  these  cases  cured,  quick 
results  were  gotten  by  the  treatment,  either  in  the  form  of  immediate  better- 
ment or  of  cure. 

These  facts  are  typical,  and  illustrate  much  that  is  seen  in  the  practice 
upon  this  class  of  cases.  They  point  prominently  to  importance  of  anatom- 
ical lesion,  of  the  kind  most  regarded  by  osteopathy,  as  the  cause  of  para- 
lytic diseases.  The  necessity  of  the  removal  of  such  lesion  in  curing  the 
condition  is  obvious.  These  facts  clearl)'  indicate  the  great  potency  of 
actual  bony  lesion,  derangement  of  a  bony  part,  in  causing  paralysis.  They 
illustrate  also  what  experience  shows  to  be  a  fact,  that  displacement  of 
spinal  vertebrae  occurs  as  the  real  cause  of  a  majorit)-  of  the  cases  of  para- 
lysis. Rib  lesions  sometimes  occur,  but  do  not  seem  to  be  important  as 
causes  of  such  disease.  The  finding  of  a  partial  dislocation  of  a  hip  as  the 
cause  of  paralysis  in  a  limb  is  a  fine  point  of  osteopathic  diagnosis.  These 
lesions  are  occasionally  found  and  are  of  prime  importance.  The)'  are 
almost  invariably  overlooked  in  the  usual  line  of  practice.  Their  reduction 
is  the  sole  and  immediate  remedy  of  the  monoplegia.  In  a  few  cases  both 
hips  have  been  found  thus  luxated  causing  apparent  paraplegia. 

Contractured  muscles  are  no  doubt  generally  secondary  lesions.  But 
with  some  frequency  the\'  have  been  found  as  the  sole  discoxerable  cause 
of  paral}'sis,  and  their  removal  has  resulted  in  cure, 

Innominate  lesion  if  found  to  be  of  the  greatest  importance  in  causing 
paralysis  of  the  lower  extremities.     The  coccyx  lesion  does  not  seem  to  be 


210  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

important  in  this  connection.  The  atlas  lesion  is  perhaps  the  most  import- 
ant single  lesion,  notwithstanding  the  fact  that  it  does  not  with  great  fre- 
quency occur  as  the  sole  cause  of  a  paralytic  condition.  Occuring  at  a  part 
of  the  spine  where  the  bones  are  small  and  the  contained  portion  of  the 
cord  large,  it  is  particularly  likely  to  impinge  upon  the  medulla  and  cause 
paral)-tic  effects  in  the  whole  body  below,  upon  one  side  of  the  body,  or  in 
the  head  and  its  parts.  As  shown  above,  lesions  of  the  atlas  occured  in  five 
of  these  cases.  It  was  present  in  two  of  these  cases  suffering  paralysis  of 
both  upper  and  lower  limbs.  In  one  of  these  cases,  in  which  also  there  was 
blindness  and  crossing  of  the  eyes,  it  was  the  sole  lesion.  Thiscircumstance 
is  well  illustrative  of  the  importance  of  the  atlas  lesion.  In  two  cases  it  was 
the  sole  lesion  causing  hemiplegia.  It  was  present  with  lesion  of  the  axis 
in  a  case  of  facial  paralysis. 

A  glance  at  the  summary  of  the  lesions  will  show  the  very  general 
range  of  these  bony  lesions.  Atlas,  axis,  cervical,  upper  dorsal,  middle  dor- 
sal, lower  dorsal,  lumbar,  innominate,  cocc)x,  hip,  rib,  and  shoulder  lesions 
were  found.  It  seems  that  an)'  movable  part  along  the  spine,  or  in  relation 
with  the  various  nerve-plexuses  concerned  in  the  various  paralysis,  may  be- 
come mib'placed  and  become  a  factor  in  producing  a  paralytic  condition. 
Yet  there  is  a  great  deal  of  constanc}'  of  lesion.  It  tends  as  much  toward 
the  specific  in  this  class  of  cases  as  in  any.  Generally  in  paraplegia,  mono- 
plegia or  paralysis  of  the  two  upper  limbs  the  lesion  is  local  at  a  place  where 
it  may  affect  the  origin  of  the  nerves  concerned  in  the  innervation  of  the 
parts  involved.  All  of  the  seven  cases  of  paraplegia  show  this  in  low  lesion 
along  the  spine.  All  the  six  cases  of  monoplegia  show  it  in  lo:al  lesions  to 
the  origins  of  the  plexuses  involved. 

It  often  happens  that  in  cases  of  paralysis  involving  the  upper  and 
lower  limbs,  one  or  both,  there  is  a  high  lesion  affecting  the  upper  and  a 
low  lesion  affecting  the  lower  members.  Yet  a  single  lesion  high  up  more 
frequently  perhaps  causes  the  trouble  in  upper  and  lower  limbs.  Lesions 
of  the  fifth  lumbar  and  of  the  innominates  are  frequent  in  paralysis  and  in 
hemiparaplegias.     These  are  important  lesions. 

An  inspection  of  the  lesions  reported  in  seven  of  the  above  paraplegia 
cases  shows  that  the  lower  dorsal  and  upper  lumbar  region  is  a  favorite 
place  for  lesions  in  such  cases;  that  spinal  curvatures  may  cause  the  condi- 
tion; that  fifth  lumbar  and  innominate  lesions  are  much  in  evidence. 

In  case  of  general  paralysis  invohing  upper  and  lower  limbs  it  is  noted 
that  atlas  lesion  alone  may  be  the  cause;  that  often  there  are  both  upper 
and  lower  lesions,  respectively  affecting  upper  and  lower  limbs;  and  that 
conlractured  muscles  and  causes  obstructing  circulation  to  the  cord  maybe 
sufficient. 

The  monoplegias  show  much  constancy  of  lesion  to  the  origin  of  the 
plexuses.     The    hip-joint,    shoulder-joint,    and  sacro-iliac    lesion  all  attract 


PRACTICE  AND  APPLIRD  THERAPEUTICS  OF  OSTEOPATHY.  211 

attention.     The  hemiplegias  seem  more  apt  to  show  single  high  lesion,  as  of 
the  atlas,  but  both  high  and  low  spinal  lesions  may  be  present. 

The  facial  paralysis  shows  almost  specific  bony  lesions.  In  three  of  the 
four  cases  the  2nd  cervical  vertebra  is  involved.  In  one  of  these  three  the 
atlas  is  also  at  fault.  In  a  fourth  case  there  was  merely  contracture  of  mus- 
cles occuring  over  the  course  of  the  trunk  of  the  nerve  were  it  crosses  the 
ramus  of  the  jaw.  In  these  cases,  bony  lesions  if  present,  are.  expected  to 
occur  among  the  upper  three  cervical  vertebra. 

Anatomical  Relations:  The  close  relation  between  the  lesion  and 
the  disease  is  shown  by  several  facts.  The  early  development  of  paralysis 
after  accident  giving  origin  to  those  lesions  found  upon  examination  to  ex- 
ist at  important  points  indicates  the  correctness  of  the  osteopathic  idea  that 
such  lesions  are  the  direct  causes.  The  further  fact  that  recovery  is  depend- 
ent upon  the  removal  of  such  lesions,  that  it  actually  is  accomplished  b)' 
their  removal,  also  shows  the  close  relation  of  lesion  to  paralytic  disease. 
Finall)'  the  Osteopath's  experience  directs  him  to  expect  bony  lesion  at 
certain  spinal  areas,  according  to  nerve-distribution  from  the  spine  to 
affected  parts.  In  all  these  cases  we  speak  of  lesion  significant  to  the  Os- 
teopath only. 

The  various  lesions,  bony  and  otherwise,  aetin  s^A^^ral  was  to  cause  the 
paralytic  effect  thai  follows  their  presence  In  the  first  place,  a  misplaced 
vertebra  or  bony  part,  or  a  contractured  muscle,  may  bring  direct  pressure 
upon  a  nerve,  a  fibre,  or  a  plexus,  cutting  off  its  function  and  causing  para- 
lysis in  its  area  of  distribution.  This  fact  is  well  shown  in  case  24.  Here 
pressure  of  the  first  dorsal  xertebra  upon  the  last  cervical  and  first  dorsal 
nerves,  one  or  both,  which  make  up  the  ulnar  nerve,  resulted  in  paralysis 
in  the  ulnar  distribution  in  the  hand,  affecting  the  little  finger,  ring-finger, 
and  in  part  the  middle  finger.  The  same  conclusion  is  indicated  b)'  the 
facts  in  case  29.  Contracture  o'f  the  hyoid  muscles  drew  the  bone  against 
the  pneumogastric  nerve,  causing  paralysis  of  the  laryngeal  muscles,  affect- 
ing deglutition  and  speech.  The  same  evidence  of  direct  pressure  upon 
nerves  is  seen  in  case  32,  where  the  muscles  contracted  over  the  trunk  of 
the  facial  nerve;  in  case  34,  where  the  head  of  the  humerus  impinged  the 
brachial  plexus;  in  case  8,  where  the  sacro-iliac  lesion  affected  the  sacral 
ner\-es.  In  all  of  these  cases  quick  results  following  the  removal  of  press- 
ure show  that  the  effect  of  the  lesion  must  have  been  directl)'  upon  the 
nerves  inxohed  by  pressure. 

In  such  cases  the  result  is  seen  to  be  directly  upon  the  part  supplied  by 
the  impinged  nerves,  it  is  uncomplicated  b)'  results  in  other  parts  of  the 
bod)-,  and  is  manifested  in  a  circumscribed  area,  namely,  in  the  muscle 
groups  supplied  by  the  nerve  or  nerves  in  question.  In  diagnosis  a  practi- 
cal point  is  to  expect  lesion  of  a  kind  exerting  direct  pressure  in  cases  pre- 
senting general  features  as  described  above.  The  lesion  is  known  at  once 
to  be  located  some  where  in  the  path  or  at  the  origin  of  the  ner\es  involved. 


212  PRACTICE  AND  AFM'LIED  THERAPEUTICS    OF  OSTEOPATHY. 

On  the  other  hand,  a  certain  class  of  lesions  is  found  causing  paralytic 
disease  by  lesion  to  the  cord.  The  effect  to  the  cord  ma)-  be  through  di- 
rect pressure  upon  it,  or  in  other  ways.  An  example  of  such  conditions  is  seen 
in  case  38.  Here  lesion  of  the  2nd  cervical  vertebra  caused  partial  paralysis 
in  one  hand,  loss  of  memor)-,  and  at  times  inability  to  articulate.  There 
was  evident  involvement  of  brain  and  cord,  and  the  lesion  was  too  high  to 
affect  the  brachial  plexus  by  direct  pressure.  In  such  case  there  is  possi- 
bility of  the  lesion  affecting  the  cord  either  by  direct  pressure  or  by  inter- 
ference with  the  s)mpathetic  or  with  cord-nutrition.  The  supposition  of  direct 
pressure  is  supported  by  the  fact  that  removal  of  the  lesion  cured  the  case 
in  one  month.  In  case  33,  formication  in  the  upper,  and  paralysis  in  the 
lower  limbs,  blindness,  unintelligible  speech,  and  paroxysms  of  spinal  pain, 
clearl)-  indicate  involvement  of  cord  and  brain.  The  lesion  of  the  3rd  cer- 
\  ical  vertebra  was  too  high  to  affect  the  brachial  plexus  by  direct  pressure; 
the  lesion  to  the  lumbar  \ertebra  likewise  could  not  have  pressed  directly 
u[)on  the  nerve-suppl)-  to  the  lower  limbs.  Vet  the  paralytic  condition  in 
lower  limbs,  referable  to  the  posterior  displacement  or  protrusion  of  the 
liuubar  vertebrae,  favors  the  theory  of  direct  pressure  upon  the  cord,  since 
such  paralysis  of  the  lower  limbs  is  known  to  follow  actual  lesion  to  the 
lumbar  segments  of  the  spinal  cord. 

In  case  36,  the  hemiplegia  resulted  from  lesion  at  the  atlas,  and  was 
cured  by  its  removal.  The  fact  that  the  child  could  walk  in  three  weeks 
after  treatment  began,  ami  the  highness  of  the  lesion,  both  favor  the  idea 
that  there  was  pressure  upon  the  cord.  In  case  7,  where  there  was  paralysis 
of  the  voluntary  muscles,  crossed  e}es,  and  partial  blindness,  the  lesion  was 
again  at  the  atlas  (occipitoa'-tlantal)  and  the  same  reasoning  would  applw 
So  in  case  6,  paraplegia  following  lesion  of  the  6th  dorsal   vertebra 

It  must  be  noted  that  in  all  these  cases  the  results  are  quite  unlike  those 
in  the  first  group  considered.  The  results,  instead  of  being  direct  upon 
nerve  or  ple.xus,  are  indirect;  the}' are  also  complicated  with  effects  in  more 
than  one  part  of  the  body,  and  are  not  circumscribed  by  being  limited  to 
one  muscle  group.  It  is  an  indication  in  diagnosis  to  expect  such  cord 
lesions  in  cases  showing  this  stvle  of  effects  from  lesion. 

In  some  cases  the  lesions  no  doubt  do  shut  off  nutrition  to  the  cord  or 
brain.  It  is  seen  in  cases  where  cervical  bony  lesion  results  in  atrophy  of 
the  optic  ner\e,  causing  blindness  through  interference  with  its  nutrition, 
(case  33;  case  7.  )  In  case  15,  lesions  were  described  as  being  present  and 
preventing  circulation  to  the  cord.  Treatment  with  the  idea  of  restoring 
this  circulation  resulted  in  quick  benefit  and  cure.  In  case  17,  the  lasting 
effects  of  the  meningitis  upon  the  cord  were  overcome  b)-  building  up  cir- 
culation to  it. 

Quickness  of  results  in  many  cases  indicates  functional  derangement 
from  pressure  of  the  lesion,  which  being  removed  leads  to  immediate  restor- 
ation of    function.     On   the  other    hand  a  course  of  treatment  must  look  to 


PRACTICE  AND  APPLIED  THERAPEUTICS^OF  OSTEOPATHY.  2I3 

regeneration  of  nerves  and  of  ganglion  cells  in  many  cases  where  degenera- 
tion has  taken  place  in  these  tissues  because  of  the  effect  of  the  lesion. 

In  hip  cases,  as  in  case  22,  the  underdevelopement  accompanjing  the 
paralysis  is  often  due  to  pressure  upon  blood-vessels  as  well  as  upon  nerves. 
The  pressure  is  from  the  displaced  bone  and  the  contractures  of  tissues. 

The  Prognosis  in  paralytic  cases  is  very  favorable.  A  large  percentage 
■of  the  cases  is  entirely  cured.  Fiew  cases  are  neither  benefitted  nor  cured. 
The  apparent  greatness  of  the  lesion  bears  no  proportionate  relation  to  the 
degree  of  the  effect.  A  small  or  very  limited  lesion  often  causes  the  most 
serious  paralysis. 

Many  cases  are  slow  and  difficult.     Some  cannot  be  cured. 

The  length  of  standing  of  the  case  should  not  determine  the  prognosis. 
Recent  cases  may  be  the  most  difficult  to  cure.  Many  of  the  mo(»t  long- 
standing and  worst  cases  are  quickly  benefitted  and  cured.  The  prognosis 
is  good,  even  after  "strokes,"  and  often  in  cases  where  there  is  blood-clot 
on  the  brain. 

Treatment:  The  bony  lesion  must  be  removed.  This  is  often  the 
only  necessary  treatment.  But  most  cases  require  a  course  of  treatment  to 
regenerate,  through  the  blood-supply,  the  nerves  and  centers  effected.  This 
necessitates  insuring  a  good  qualit}'  of  blood,  and  in  many  such  cases  the 
important  first  step  consists  in  sufficient  treatment  to  bowels,  stomach,  liver 
and  kidnej-s  to  improxe  the  general  health  and  expell  all  impurities  from 
the  blood. 

The  general  spinal  and  cervical  treatment  should  be  applied  to  tone  the 
general  nervous  system  and  to  increase  the  circulation  and  nutrition  of  it. 
This  is  accomplished  b\'  relaxation  of  all  the  spinal  tissues,  separation  of 
the  spinal  vertebrae  to  allow  free  circulation,  and  stimulation  of  the  central 
distribution  of  the  sympathetic  having  control  of  circulation  to  the  spine. 

In  case  of  blood-clot  upon  the  brain  the  treatment  is  to  increase  cervi- 
cal circulation  to  absorb  it.  This  can  be  accomplished  in  cases  where  the 
clot  has  not  had  time  to  become  organized  or  encx'sted.  After  cerebral 
hemorrhage,  treatment  should  keep  this  object  constantly  in  mind.  But  in 
many  old  cases  of  hemiplegia  after  cerebral  apoplexy,  where  doubtless 
the  clot  has  become  organized,  much  benefit  can  be  gi\-en  b)-  the  treatment. 

Local  treatment  is  made  upon  the  paralyzed  limb  or  part  to  soften 
contractures,  build  up  circulation,  increase  nutrition  of  the  tissues,  and  to 
tone  the  local  ner\-e-mechanism. 

Lesions  as  described  in  this  chapter  will  be  found  in  most  of  the  vari- 
ous diseases  of  brain  and  spinal  cord.  The  same  principles  and  methods 
of  treatment,  varied  to  suit  the  case,    may  be  applied  to  them. 

For  example,  in  Cerebral  Hemorrhage,  or  Cerebral  Apoplexy^ 
strong  inhibition  is  made  at  once  upon  the  sub-occipital  regions  to  dilate 
the  blood-vessels  and  to  aid  in  reducing  the  congestion.  This  object  is 
aided  in  a  most  important  manner  b)'  the  general  cervical,    spinal    and    ab- 


214  PRACTICE    AND  ArrLIED  THERAPEUTICS  OF  OSTEOPATHY. 

dominnl  treatment,  relaxing  all  tissues  and  calling  the  blood  to  these  parts 

away  from  the  head.     These  treatments  should  be  rela.xing    and    inhibitive 

in  nature    as   before    described.     The  head  should   be  kept  raised  to  aid    in 

drawing  the   blood    from  it.     In   the    intervals    of    treatment    the    ice-bag 

ma)-  be  applied  to  the  head,  hot  ap|)lications  to  the  feet,  and  counterirritants 

to  the  spine.     The  patient  should  remain  cjuietly  in  bed  and  be    fed    upon  a 

liquid  diet. 

After  the  acute  stage  the  treatment  should  be  carried  on  to  remove  the 

blood-clot  from  the  brain  and  to  overcome  the  hemiplegia.     The    former  is 

accomplished  b\-  the  usual  cervical  treatments  to  increase  circulation  to  the 

brain;  the  latter  by  such  treatment  as  described  in  detail  above  for  cases    of 

paralysis.     The  clot  ma\-.  if  taken  in  time,  be  completely  removed,  and  the 

patient  may  be  completely  cured  of  all  paralysis.      During  the  acute  stages 

the  patient  should  be  seen  twice  or  several  times   daily.      Later    he  ma}-  be 

treated  daily  or  three  times  a  week. 

In  the  various  forms  of  Spinal  Me.vingitis,  often  met  in  our  practice, 
good  prognosis  is  the  rule.  Cases  are  made  to  recover  entirely,  all  paralysis 
or  lingering  stiffness  of  the  muscles  being  overcome.  The  treatment  in  the 
acute  form  is  the  general  spinal,  cervical,  and  abdominal,  to  control  the  cir- 
culation of  the  cord  and  call  the  blood  away  from  it.  Tne  rigidity  of  the 
muscles  is  overcome  by  manipulation  and  by  careful,  inhibitive  spinal  treat- 
ment. Bowels  and  kidneys  must  be  kept  active  b)'  treatment,  to  aid  in  re- 
moving toxic  products  from  the  s)'stem.  It  may  be  necessary  to  use  a 
catheter  on  account  of  the  paralysis  of  the  sphincter  of  the  bladder.  In  the 
intervals  of  treatment  ice-bags  may  be  applied  along  the  spine.  A  course 
of  treatment  should  be  carried  on  to  insure  complete  resorption  of  the  in- 
flammatory products  from  about  the  cord,  and  to  prevent  or  overcome  any 
parah  tic  sequel  to  the  condition. 

In  Myelitis  the  same  general  plan  of  treatment  should  be  adopted  to 
gain  vaso-motor  control  and  lessen  the  inflammatory  process  in  the  cord. 
Diagnosis  should  be  made  of  the  jiortions  of  the  cord  affected,  and  treat- 
ment should  be  applied  here  particularly  to  absorb  the  extravasated  blood 
and  do  away  with  the  danger  of  softening  or  degeneration  of  the  cord  fol- 
lowing. The  patient  should  be  keep  quiet,  and  attention  be  given  to  any 
special  manifestation  in  the  case  requiring  alleviation.  Care  must  be  taken 
in  the  manipulation  to  avoid  all  irritation  of  the  skin  on  account  of  the 
liability  to  bed-sores.  Rigidit)-  and  spasm  in  the  affected  muscles  may  be 
overcome  by  inhibitixe  manipulation  of  them,  and  by  inhibition  of  the 
nerves.  Guard  against  renal  and  pulmonary  co;iiplications  b)-  keeping  the 
lungs  and  kidneys  well  stimulated.  A  course  of  treatment  must  follow  to 
guard  against  or  overcome  paral)sis.  The  prognosis  is  good  in  the  acute 
case.     A  chronic  case  maj-  be  cured,  or  much  may  be  done  for  its  benefit. 

In  meningitis,  myelitis,  apolexy,  etc.,  various  spinal  and  cervical 
lesions  occur,  of  the  kinds  pointed  out  in  the  general  consideration  of  the 
subject  of  paralysis. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  21  J 


INSANITY. 

Cases:  (i)  Farmer,  injured  while  at  work,  later  became  insane. 
Treatment  by  the  usual  methods  did  not  avail  and  preparations  were  made 
to  take  him  to  an  asylum.  He  had  been  insane  for  some  months,  when  the 
osteopathic  examination  was  made.  Four  men  were  required  to  hold  the 
patient  during  the  examination,  so  violent  had  he  became.  Lesion  was 
found  as  a  marked  displacement  of  the  third  cervical  vertebra  to  the  right. 
It  was  set  at  once,  and  the  patient  immediatel)'  fell  asleep,  sleeping  for 
twelve  hours  and  awaking  rational.     In  a  few  da)'s  the  patient  was  well. 

(2)  A  young  lady,  violentl\'  insane  for  six  }'ears.  Lesion  was  found 
as  a  slightly  misplaced  atlas,  which  was  corrected  at  one  treatment.  The 
symptoms  of  insanity  all  disappeared  in  a  few  days.  There  was  history  of 
a  fall  six  )ears  previous  to  the  development  of  the  insanit>%  and  it  was 
thought  that  the  luxation  of  the  atlas  was  caused  then. 

(3)  A  young  woman  of  twenty-four,  insane  and  confined  in  an  asylum 
for  eight  months.  Lesion  existed  in  the  form  of  a  double  lateral  curvature 
in  the  lumbo-dorsal  region;  5th  lumbar  \ertebra  posterior;  4th  dorsal  mark- 
edly posterior;  3rd  and  5th  dorsal  anterior;  7th  and  Sth  right  ribs  pressing 
upon  the  liver;  innominates,  one  forward  and  the  other  back,  one  limb  being 
I  inch  longer  than  than  the  other.  Treatment  directed  to  the  correction  of 
these  lesions  caused  immediate  benefit,  and  the  patient  was  apparentl)'  vvell 
after  two  weeks'  treatment. 

(4)  In  a  lady  of  twent}',  insanit)'  of  two  months'  standing.  There  was 
a  history  of  attacks  of  marked  cerebral  congestion.  At  times  she  became 
violent.'  The  lesions  were  great  tenderness  and  tension  in  the  cervical  re- 
gion abo\-e  the  4th  vertebra,  but  no  bony  lesion;  tenderness  at  the  5th  lum- 
bar vertebra  and  over  the  left  ovary.  Dysmenorrhoea  was  present.  After 
the  first  treatment  she  slept  tor  eleven  hours,  and  awoke  sane  for  the  first 
time  in  eight  months.     After  three  weeks'  treatment  the  patient    was    well. 

(5)  A  boy  acted  in  an  insane  manner  after  a  fall  upon  his  head  from 
a  window.  A  cervical  vertebra  was  found  luxated,  and  one  treatment  suf- 
ficed to  cure  the  case. 

(6)  A  lady  of  thirt)--eight,  who  had  been  a  chronic  sufferer  from  rheu- 
matism, had  become  insane  ten  years  previonsly  to  treatment.  At  the  time 
of  becoming  insane  the  menses  had  ceased.  She  had  been  in  an  asylum  for 
six  months,  growing  continually  worse.  She  was  much  excited  and  suffer- 
ed hallucinations.  The  lesions  were  such  as  pertained  to  the  rheumatic 
condition;  general  muscular  contracture,  joints  somewhat  stiffened,  tender- 
ness over  the  kidne}-s,  feeble  pulse,  and  subnormal  temperature.  One 
month  of  treatment  showed  great  improvement;  after  two  months  the 
menses  were  reestablished  and  the  mind  was  nearly  normal.  Recovery  was 
complete. 


2l6  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV 

(/)  Insanit)-  in  a  man  followed  injury  in  a  runawa)'  accident.  Lesion 
existed  as  anterior  displacement  of  the  atlas  and  a  twist  of  the  second  and 
third  vertebrae,  one  being;  turned  forward  and  the  other  backward.  There 
was  also  contraction  and  soreness  of  the  posterior  cer\ical  muscles.  Con- 
tinued pain  existed  at  the  top  of  the  head,  there  was  an  eruption  upon  the 
face,  and  a  marked  abnormal  pulsation  of  the  abdominal  aorta.  Treatment 
soon  cured  the  case. 

The  cases  are  illustrative  of  osteopathic  practice  in  insanit)',  numerous 
cases  of  which  come  under  treatment.  As  a  rule  bony  lesions  are  found. 
Sometimes  lesion  exists  in  the  form  of  merely  muscular  contracture  in  the 
cervical  region.  The  lesions  are  generally  in  the  cervical  region.  Fi\e  of 
the  above  seven  cases  presented  such  lesion.  Atlas  lesion  is  frequent.  In 
some  cases  are  general  spinal  lesions  leading  to  effects  upon  the  nervous 
system.  Often  marked  lesion  is  found  in  the  dorsal  region.  McConnell 
notes  the  occurrence  in  insanity  of  middle  dorsal,  renal  splanchnic,  and  rib 
lesions.  The  latter  occur  among  the  middle  ribs  on  the  right  side.  Case 
3  above  shows  such  lesions. 

Lesions  act  by  interfering  with  cerebral  circulation,  probably  in  some 
cases  by  pressure  upon  the  cord,  and  also  by  affecting  the  nervous  system 
and  setting  up  reflexes.  On  the  whole  but  little  can  be  said  definitel)-  in 
regard  to  the  pathology  of  insanity  from  the  osteopathic  point  of  view. 
That  lesions  exist  as  the  cause  of  such  conditions,  and  that  their  removal 
cures,  and  alone  can  cure,  them,  cannot  be  doubted  from  the  facts.  But 
just  how  lesion  is  acting  to  cause  derangement  of  the  mental  functions  is 
not  known.  It  is  noticable  that  quick  results  usually  follow  treatment,  as 
in  the  seven  cases  above.  Often  the  patient  falls  at  once  into  a  deep  and 
lasting  sleep,  These  facts  indicate  some  marked  and  immediate  relief  to 
the  brain.  It  seems  as  if  some  great  pressure  had  been  taken  off  the  brain, 
leaving  the  mind  free  and  Nature  unopposed  in  her  work  of  repair.  This  is 
doubtless  literally  true  in  those  cases  of  insanity  attended  b}'  cerebral  con- 
gestion, in  which  the  impeded  circulation  is  at  once  restored  to  normal  ten- 
sion b\' removal  of  that  which  impedes  the  venous  flow  from  the  head. 
When  the  lesion  is  cervical  it  is  altogether  likely  that  its  action  upon  the 
brain  is  b}-  deranging  the  cerebral  circulation,  either  by  direct  pressure  upon 
the  vertebral  arteries  by  a  displaced  vertebra,  by  irritation  to  cervical  sym- 
pathetics  and  the  vaso-motor  center  in  the  medulla,  or  by  a  combination  of 
these  two.  In  this  way  may  be  set  up  either  hyperemia  or  anemia  of  the 
brain.  For  example,  pressure  upgn  the  vertebral  arteries  and  irritation  to 
the  vaso-motors  causing  vaso-constriction  might  co-operate  to  cause  marked 
anemia  of  the  brain.  On  the  other  hand,  impeded  \enous  return  and  in- 
creased arterial  tension  in  this  region  might  result  from  lesion  and  cause 
cerebral  hyperemia.  Many  cases  of  insanit)-  are  met  in  which  there  is 
hyperemia,  as  in  cases  4  and  7. 

That    h)peremia    and    anemia  are  important   in    relation  to  insanity  is 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  217- 

shown  by  the  statement  of  Kellogg  that  "insanity  from  circulatory  disord- 
ers of  the  brain  arises  chiefly  in  intense  hyperemic  and  anemic  forms." 
That  osteopathic  lesion  profoundly  affects  cerebral  circulation  is  e\idenced 
by  many  facts  in  the  treatment  of  various  diseases.  The  importance  of 
these  circulatory  disturbances  is  further  indicated  by  Kellogg's  statement 
that  vascular  degenerations  deprive  the  brain  of  its  customary  blood-supply 
and  also  prevent  elimination  of  the  waste  products  of  cellular  activity.  It 
is  evident  that  the  lesion  shutting  off  the  arterial  supply  or  preventing  free 
circulation  in  the  brain  could  act  as  could  vascular  degenerations  in  produc- 
ing the  effects  mentioned.  Kellogg  says  it  is  freely  admitted  that  then  is  a 
pre\ious  link  in  the  chain  of  events  leading  to  insanity  from  such  causes  as 
he  mentions  above.  This  link  the  Osteopath  supplies  by  noting  these  im- 
portant bony  and  other  lesions,  without  the  removal  of  which  these  cases 
fail  to  be  cured. 

It  is  likely  that  the  atlas  lesion,  so  often  found  in  insanity,  acts  chiefly 
by  deranging  the  circulation  through  its  close  relations  to  the  superior 
cervical  ganglion  and  the  medulla.  It  does  not  seem  that  this  and  other 
cervical  bon)'  lesion  cause  direct  pressure  upon  the  cord,  as  in  such  case  one 
would  expect  paralysis  in  the  body  below,  yet  it  is  not  impossible  that  it 
may  press  directl}'  upon  the  cord,  getting  its  effect  upon  the  brain  through 
ascending  tracts. 

The  general  spinal,  vertebral  and  rib  lesions  mentioned  may  affect  the 
general  nervous  system,  as  is  known  to  be  a  fact  from  a  study  of  nervous 
diseases,  (see  Paralysis)  in  this  way  leading  to  nervovs  diseases,  reflex  and 
otherwise,  which  are  at  the  basis  of  insanity  "All  the  (various  influences) 
acting  in  the  production  of  general  diseases  of  the  nervous  system  are  those 
fundamentall)'  in\'olved  in  the  causation  of  insanity,"  (Kellogg).  The 
splanchnic,  right  rib,  and  renal  lesions  noted  by  osteopathy  as  present  in  in- 
sanity cases  may  cause  insanit)^  through  derangement  of  kidneys,  liver  and 
gastro-intestinal  tract.  The  fact  is  noted  by  writers  upon  insanity  that 
kidne)'  diseases,  notably  Bright's  disease,  and  gastrointestinal  conditions, 
as  gastric  and  intestinal  catarrh,  are  sometimes  closely  associated  with  the 
causation  of  insanity.  Likewise  liver  disease  is  well  known  to  be  closely 
connected  with  insanit)',  gall-stones  and  icterus  being  common  in  insanity. 
These  visceral  diseases,  as  well  as  some  nervous  diseases  seem  to  be  related 
to  insanity  through  the  vaso-motor  reflexes  they  arouse.  Kellogg  says, 
''vaso-motor  disorders  essentially  constitute  the  connecting  link  in  the 
causation  of  insanit)'  by  visceral  affections  and  peripheral  nervous  diseases. 
The  \'aso  motor  center  in  the  medulla  is  under  the  reflex  control  not  alone 
of  the  cerebral  cortex,  but  of  the  entire  peripheral  distribution  of  the  sen- 
sor)- nervous  s)stem,  so  that  not  onl)'  emotional  stimuli,  but  peripheral  ir- 
ritations, ma)'  affect  circulatory  changes  and  variations  in  the  blood-pres- 
sure which  stand  in  poximate  relation  to  mental    disorder." 

It    is  a    well  demonstrated  fact  that  osteopathic  lesion  causes  not  only 


2l8 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 


the  visceral  diseases,  but  likewise  marked  vaso-motor  disorders,  'etc.,  ap- 
parently so  closely  related  to  these  brain  conditions. 

In  view  of  these  various  facts  it  seems  that  the  Osteopath  has  in  in- 
sanity a  broad  field  for  his  labors.  Nor  would  he  be  confined  to  that  class  of 
cases  in  which  the  traumatic  effects  of  lesions  due  to  violent  accidents  and 
the  like  are  the  causes  of  insanity.  But  as  it  is  evident  that  the  various  le- 
sions, bony  and  otherwise,  that  he  finds  may  become  fundamental  to  the 
causation  of  insanity  through  producing  visceral,  nervous,  and  vaso-motor 
disorders,  his  field  in  insanitv  must  be  as  broad  as  the  disease. 

The  Pro(;nosis  is  good.  The  most  brilliant  and  quickest  results  are 
often  attained,  A  large  percentage  of  the  cases  treated  are  cured.  It  is 
needless  to  say  that  many  cannot  be  cured. 

The  Treatment  looks  to  the  removal  of  lesion,  and  of  all  causes  of 
irritation,  reflex,  emotional  and  otherwise.  The  whole  nervous  system 
should  be  upbuilt  by  general  spinal  and  cervical  treatment.  One  of  the 
main  objects  is  to  correct  cerebral  circulation.  A  congested  condition  is 
treated  as  in  congestive  headache  or  apoplexy,  q.  v.  The  abdominal  in- 
hibition may  be  employed.  The  general  health  is  looked  tD,  kidneys,  liver, 
stomach,  bowels,  pelvic  viscera,  heart  and  lungs  are  all  regulated  in  case  of 
affection  in  them.     The  patient  should  lead  a  quiet,  regular  life. 


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PRACTICE  AND  APPLIRD  THERAPEUTICS  OF  OSTEOPATHY.  221 


DISEASES  OF  THE  EYE. 

Cases:  (i)  Impaired  vision  in  a  boy  of  seventeen,  who  had  been 
wearing  glasses  over  three  years.  Severe  hsadache  and  inability  to  read 
followed  removal  of  them.  Lesion  was  found  as  lateral  luxation  of  the 
atlas  and  third  cervical  vertebra.  After'three  weeks' treatment  the  glasses 
were  removed,  and  at  the  end  of  two  months  the  eyes  were  completely 
cured.     The  report  was  made  six  months  later,  the  eyes  still  being  well. 

(2)  In  a  case  of  weak  eyes  the  glasses  were  laid  aside  permanently 
after  one  month's  treatment. 

(3)  Weak  eyes,  which  for  two  years,  had  required  the  use  of  spectacles, 
were  cured  at  the  second  treatment  by  adjustment  of  cervical  bony  lesion. 
The  glasses  were  at  once  laid  aside. 

(4)  A  young  man  of  eighteen  had,  for  twelve  years,  been  forced  to 
wear  spectacles,  in  spite  of  which  the  eyes  continued  to  grow  weaker.  He 
had  to  give  up  school  work.  Under  osteopathic  treatment  he  laid  aside  the 
glasses  after  three  treatments.  No  further  treatment  was  required.  Five 
months  later  the  eyes  were  still  well. 

(5)  A  case  in  which  weakness  of  the  eyes  and  rheumatic  pains  in  the 
shoulder  were  caused  lesion  in  the  form  of  closeness  of  the  second  and  third 
cervical  vertebrae.  After  one  treatment  the  glasses  werelaid  aside  and  the 
pain  in  the  shoulder  was  gone.  The  trouble,  caused  by  a  fall  in  a  gymnas- 
ium, affected  but  one  eye  and  one  side  of  the  body,  a  nervous  twitching  of 
the  muscles  being  present. 

(6)  A  young  lady  had  suffered  with  weak  eyes  for  two  years.  The 
eyes  would  be  very  painful  if  the  glasses  were  laid  aside  even  for  five  min- 
utes. Lesion  was  of  the  2nd  dorsal  vertebra,  lateral  to  the  left.  After  five 
treatments  the  glasses  were  discarded. 

(7)  In  a  lady  of  forty,  weakness  of  the  eyes,  accompanied  by  great 
pain  in  the  eyeballs  and  at  the  base  of  the  brain.  Lesion  existed  at  the 
atlas  and  third  cervical  vertebra.  Constipation  and  uterine  prolapsus  were 
present,  with  characteristic  lesions.  After  one  month  the  eyes  were  almost 
well.     Photophobia  was  a  feature  of  the  case. 

(8)  In  a  cases  of  weak  eyes,  with  pain  in  the  neck,  occipital  headache, 
and  a  complication,  ot  troubles  lesions  were  found  as  anterior  luxation  of 
3rd,  4th,  and  5th  cervical  vertebrae,  the  5th  being  sore.  The  whole  spinal 
column   was  stiff  and  stooped  forward. 

(9)  In  a  case  of  weak  eyes  in  a  young  man  of  twenty,  of  two  month's 
standing,  the  patient  was  unable  to  read,  the  balls  were  injected  and  pain- 
ful, and  the  lids  were  inflamed.     The  atlas  and  axis  were  too  close. 

(10)  In  a  lady  of  thirty-two,  weakness  of  the  eye  and  chronic  hoarse- 
ness had  existed  for  twenty-two  years.  The  left  cervical  muscles  were  very 
sore,  there  was  a  separation  between  the  atlas  and  axis,  and  the  5th  cervical 
vertebra  was  sore.     The  right  tear  duct  was  closed. 


222  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

(I  i)  In  a  case  o(  weakness  of  the  eyes,  coupled  with  indigestion,  j  lun- 
dice  and  hemorrhoids,  the  7th  to  i»th  dorsal  vertebrae  were  posterior; 
coccyx  anterior;  an  innominate  forward. 

(12)  Extreme  weakness  of  the  eyes,  together  with  female  disease.  A 
few  minutes'  use  of  the  eyes  caused  violent  headache.  L-^sions  were  at  the 
atlas  and  in  a  tilting  of  an  innominate  bone.  The  case  was  cured  by  re- 
moval of  the  lesions. 

(13)  Eye  trouble  in  a  boy  of  thirteen,  not  benefitted  by  glasses.  Pa- 
tient was  very  nervous.  The  atlas  was  slipped  forward.  The  lesion  was 
corrected  and  the  case  cured  in  six  weeks. 

(14)  A  case  of  pterygium  due  to  granulated  lids  of  sixteen  years' 
duration.  The  left  pupil  was  covered  by  the  growth,  and  the  right  one  was 
nearly  so.     The  case  was  cured  by  the  adjustment  of  cervical  lesion. 

(15)  Pterygium  o\er  each  eye  due  to  lesion  of  the  atlas.  Under  treat- 
ment gradual  correction  of  the  lesion  was  accompanied  by  gradual  absorp- 
tion of  the  growth. 

(16)  Partial  blindness  and  strabismus,  associated  with  general  paraly- 
sis, due  to  a  forward  slip  of  the  head  upon  the  atlas.  The  case  was  cured  in 
two  months. 

(17)  A  case  01  blindness  from  optic-nerve-atrophy,  due  to  a  fall  from 
a  swing,  resulting  in  lesion  of  the  atlas  and  several  cer\  ical  and  upper  dor- 
sal vertebrae.  The  disease  was  of  twenty-three  years'  standing  It  was 
cured  by  two  years'  treatment. 

(18)  Blindness  of  one  eye,  and  almost  total  loss  of  sight  in  the  other 
of  about  a  )  ears'  duration,  was  cured  in  two  weeks  by  correction  of  lesion  of 
the  atlas,  which  was  displaced  to  the  right,  and  of  one  of  the  first  ribs,w^hicb 
was  luxated  upwards. 

(19)  Partial  blindness,  the  patient  being  unable  to  read  or  to  recog- 
nize a  person  ten  feet  away.  The  trouble  was  due  to  starvation  of  the  optic 
rerve  from  lesion  of  the  upper  cervical  vertebrae.  In  four  months  the  pa- 
tient had  been  cured. 

(20)  Blindness,  almost  total,  in  a  min  of  sixty,  due  to  a  fall  when  he 
was  a  child.  Lesion  was  found  as  luxation  of  a  cervical  vertebra.  The 
treatment  so  benefitted  the  eye  that  it  could  see  to  read  coarse  print. 

(21)  A  case  of  cataract  reported  cured,  the  patient's  oculist  verifying 
the  report. 

(22)  Total  blindness  in  the  left  eye  for  more  than  two  years,  due  to 
lesion  of  the  atlas.  The  pupil  was  much  dilated.  After  one  treatment 
sight  was  partly  restored,  and  at  the  end  of  a  month  of  treatment  the  case 
was  nearly  entirely  well. 

(23)  Total  blindness  with  paralysis  of  lower  limbs,  formication  of 
upper  limbs,  etc.  Lesion  was  found  in  lateral  luxation  of  the  third  cervical 
vertebra,  of  the  7th  and  8th  right  ribs,  and  posterior  protrusion   of  the  lum- 

ar  vertebrae.     Soon  vision  was  partly  restored,  but  with   diplopia.     Slight 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  223 

pressure  upon  the  seventh  cervical  vertebra  would  at  once  restore  perfect 
vision.  When  pressure  was  removed  diplopia  again  occured.  Under  fhe 
treatment  the  sight  was  entirely  restored.  Speech  had  been  lacking,  but  was 
restored,  and  the  paralysis  was  cured. 

(24)  In  a  young  man  of  twenty,  diplopia  of  two  years'  duration  had 
followed  a  severe  attack  of  measles.  The  3rd  cervical  vertebra  was  dis- 
placed anteriorly  and  the  tissues  about  it  were  sore.  Tenderness  existed 
also  at  the  5th  and  6th  cervical  vertebrae.  The  first  dorsal  was  posterior, 
the  2nd  to  6th  flattened,  the  8th  to  12th  weak,  with  a  separation  between  the 
I2th  dorsal  and  ist  lumbar,  and  the  ist  to  4th  lumbar  vertebrae  were  poster- 
ior, The  case  was  cured  in  one  month.  There  had  been  sugposed  hem- 
orrhagic retinitis. 

(25)  A  case  of  strabismus  due  to  lesion  of  the  2nd  dorsal  vertebra  was 
cured  by  correction  of  the  lesion.  During  the  course  of  treatment,  after  the 
eyes  had  first  become  straightened  pressure  upon  the  second  dorsal  vertebra 
would  cross  them  again. 

(26)  A  case  of  strabismus,  unilateral,  convergent,  due  to  a  fall  in  a  run- 
away accident.  The  atlas  was  displaced  to  the  right;  4th  and  5th  cervical 
vertebrae  anterior.     The  case  was  improving  under  treatment. 

(27)  Kerito-conjunctivitis,  in  the  left  eye,  of  four  years'  standing. 
There  was  opacity  of  the  upper  two-thirds  of  the  cornea,  with  marked  vas- 
cularization, inflammation  and  granulation  of  the  eyelids,  and  injection  of 
the  sclerotic.  The  atlas  was  luxated  to  the  left,  the  fifth  and  sixth  cervical 
vertebrae  were  anterior  and  to  the  left,  and  the  upper  dorsal  vertebrae  were 
posterior.  Under  the  treatment  the  case  was  almost  cured  in  less  than  two 
months. 

(28)  In  a  man  of  thirty-seven,  glaucoma  was  present,  and  total  blind- 
ness of  the  left  e\e  was  predicted  by  the  oculist.  The  patient  was  a  neuras- 
thenic probably  of  the  cerebral  type,  pain  in  the  head  and  eye  being  ex- 
treme. The  eye  trouble  was  overcome  and  the  patient's  general  condition 
much  improved  by  three  months'  treatmeut.   No  especial  lesions  were  found. 

(29)  Partial  blindness,  in  which  the  blindness  was  limited  to  a  circular 
portion  of  each  e\e.  Lesion  was  found  as  a  luxation  of  the  atlas  to  the 
light  and  backwards.     The  case  is  still  under  treatment. 

(30)  A  case  in  which  the  tear-duct  was  closed.  It  had  been  growing 
worse  under  the  usual  form  of  treatment  for  two  years.  The  eye  was  much 
inflamed.  Relief  was  experienced  at  the  first  treatment,  after  the  second 
the  duct  was  permanently  opened,  and  the  inflammation  about  the  eye  grad- 
ually disappeared.     The  case  was  well  a  }'ear  later. 

(31)  Eye-strain,  causing  constant  headache,  due  to  a  luxated  atlas. 
Glasses  gave  no  relief.  The  headache  did  not  recur  after  the  first  treatment, 
and  the  eyes  were  well  after  seven  treatmeats.  The  case  had  been  of  but 
two  or  three  months'  standing. 

(32)  Astigmatism   in  a  girl  of  ten.      Lesion  was  found  at  the  2nd  dor- 


224  FKACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV. 

sal.     Treatment  was  directed  to  correction  of  this  lesion   uid  to  stimulation 
of  the  ocular  blood  and  nerve-supply.     The  case  was  soon  cured. 

(33)  In  astigmatism  for  which  the  patient  had  worn  spectacles  for  nine 
years,  lesion  was  found  in  anterior  luxation  of  the  atlas  and  a  twist  of  the 
inferior  ma.xillary  bone.  The  glasses  were  permanently  discarded  after  one 
treatment,  and  the  case  was  soon  entirely  cured. 

Lesions:  Of  the  33  cases  above,  27  report  lesion,  and  in  each  case  bony 
lesions  were  present.  Contracture  was  also  noted  in  one  case.  Of  these 
"•T  lesion?.  21  were  cer\  ical  bonv  lesions  and  two  were  muscular  contrac- 
lures.  Preponderance  of  atlas  lesion  was  seen  in  the  cervical  region,  16  of 
the  27  being  such.  Numerous  lesions  occured.  Among  the  other  cervical 
vertebrae  were  lesions  as  follows:  Axis,  3;  3rd  cervical,  6;  4th  cervical,  2; 
5th  cervical,  5;  6th  cervical,  2. 

Upper  dorsal  lesions  were  present  in  8  cases,  7  being  bony  lesions. 
These  lesions  extended  as  low  as  the  6th  dorsal  vertebra,  as  follows:  ist 
dorsal,  2;  2nd  dorsal,  5;  3rd  dorsal,  2;  4th  dorsal,  2;  5th  and  6th  dorsal  each 
one. 

Oth  r  bon)-  lesions  occuring  in  these  caser,  and  of  importance  in  eye 
troubles  generall)-,  are  luxation  of  the  inferior  maxillar)-  bone  and  of  the 
first  rib,  sometimes  also  of  the  clavicle. 

These  reports  illustrate  very  well  the  general  lesions  fcund  in  diseases  •f 
the  eye.  The  most  important  lesions  occur  among  the  vertebrae  of  the 
cervical  and  upper  dorsal  region.  Muscular  lesions  are  often  found  in  this 
region,  and  are  of  considerable  importance.  The  whole  cer.vical  region  is 
frequently  involved,  or  any  one  or  several  of  the  \-ertebrae  may  be  luxated. 
Perhaps  the  more  important  lesions  are  of  the  atlas,  axis,  and  3rd  cervical 
vertebra.     The  4th  and  5th  are  also  important. 

There  is  a  form  of  neck  lesion  thar  often  plays  a  part  in  the  production 
of  eye  disease,  as  well  as  of  other  forms  of  head  and  neck  trouble.  It  in- 
volves the  whole  cervical  region,  often  causing  a  lateral  swerve  of  the  cervi- 
cal spine.  The  cervical  tissues  are  contractured  or  hypertrophiel  upon  one 
side  more  prominentl)-  than  upon  the  other.  The  condition  is  often  evident 
upon  simple  in  spection  from  immediately  behind.  The  fullness  upon 
one  side  of  the  neck,  and  generally  a  corresponding  depression  in  the  tissues 
on  the  opposite  side,  are  readily  seen.  In  some  cases  the  condition  is  better 
appreciated  upon  palpation.  The  fingers  ar<:  readily  pressed  more  deeply 
into  the  tissues  upon  one  side  of  the  posterior  cervical  aspect  than  upon  the 
other.  Contracture  of  the  muscles  may  be  felt  here  on  both  sides.  If  the 
vertebrae  are  traced  down  the  mid-line  of  the  back  of  the  neck,  a  lateral 
swerve  is  often  evident.  In  other  cases  the  bony  lesions  are  more  evident 
by  examination  of  each  verteba  with  the  patient  I)'ing  upon  his  back. 

Dr.  A.  T.  Still  calls  attention  to  the  fact  that  contracture  of  the  cervical 
muscles  opposite  the  4th  vertebra  are  common  in  eye-diseases,  and  that 
pressure  here  causes  pain  in  the  e)e.     A  case  is  reported  in  which  pressure 


v>RACTlCE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  22$ 

between  the  2nd  and  3rd  dorsal  v^ertebrae  upon  th€  right  side  revealed  ten- 
derness at  that  point  and  also  caused  pain  in  the  e)e. 

Without  question  cervical  bony  lesion  is  the  most  important  one  with 
which  the  Osteopath  deals  in  eye-diseases. 

Upper  dorsal  lesion  may  be  muscular,  but  is  usually  lx>ny.  It  involves 
chiefly  the  upper  four  or  five  vertebrae,  but  may  extend  as  low  as  the  6th  or 
seventh.  The  lesions  of  the  ist,  2nd  and  3rd  dorsal  vertebrae  are  the  most 
important  here.  A  common  abnormality  of  the  anatomical  parts  here  is  a 
"'hump"  or  prominent  cushion  of  flesh  covering  the  spinous  processes  of  the 
upper  two  or  three  dorsal  vertebrae.  There  is  often  conjoined  with  this  con- 
"d  it  ion  a  marked  prominence  of  the  first  dorsal  spine  from  above,  as  if  the  cer- 
vical spine  had  been  moved  a  little  anteriorly  upon  the  first  dorsal.  This  cush- 
ion is  a  common  condition  in  eye  troubles  of  various  sorts,  and  is  sometimes 
connected  with  heart- trouble. 

Among  lesions  of  this  region  may  be  mentioned  lesiou  of  the  upper  ribs 
on  either  side  as  low  as  tlie  sixth,  sometinies  thought  to  have  as  bearing  upon 
nutritional  disturbances  of  the  eyes. 

We  are  perhaps  not  in  a  pcsition  or  yet  to  point  out  that  special  kinds  or 
locations  of  lesion  result  in  specific  di.sea.ses  of  the  eye.  Cases  involving  defi- 
ciency somewhere  in  the  optic  tract  seem  to  favor  lesion  in  the  upper  cervical 
region.  In  the  above  reports,  19  cases  in  which  probably  the  intrinsic  apparatus 
of  the  special  sense  of  sight,  was  involved  such  as  weakness, impaired  vision, blind- 
ness, etc., show  lesion  chiefly  in  the  upper  cervical  region.  All  but  two  cases  show 
cervical  lesion,  13  of  them  being  entirely  in  the  cervical  region;  1 1  at  the  atlas; 
8  at  the  axis,  third,  or  both;  also  the  4th,  5th  and  7th  were  involved.  The 
most  important  lesions  occured  about  atlas,  axis,  and  third. 

Cases  in  which  there  is  nutritional  disturbance,  as  in  conjunctivitis,  kera- 
titis, glaucoma,  cataract,  and  closure  of  the  tear-duct,  also  cases  in  which  there 
is  structural  change,  such  a-^  astigmatism,  pterygium,  etc.,  probably  due  10 
lack  of  nutrition,  present  atlas,  general  cervical,  inferious  maxillary, and  upper 
dorsal  lesiou.  Compilations  of  data,  by  which  proof  of  these  matters  might 
be  made,  are  lacking.  Yet  it  seems  that  nutritional  disturbances,  involving  in 
some  way  chiefly  the  fifth  nerve,  would  be  found  tending  more  toward  the 
upper  dorsal  region,  for  the  anatomical  reason  that  this  nerve  has  important 
connections  with  the  upper  dorsal  nerves  and  cord. 

Motor  disturbances,  such  as  diplopia,  strabismus,  eye  strain,  etc.,  show 
less  of  high  cervical  le.sion  and  more  from  about  the  third  cervical  down  to  the 
upper  dorsal.  In  this  connection  it  is  recalled  that  diplopia  has  been  caused  b}' 
pressure  at  the  7th  cervical,  and  strabismus  by  pressure  at  the  2nd  dorsal. 

This  phase  of  the  subject,  inquiry  how  far  specific  lesion  results  in  a  cer- 
tain form  of  eye  disease,  presents  a  good  field  for  research.  It  is  evident  that 
at  present  we  cannot  more  than  indicate  probabilities. 

Anatomical  Relations:  There  are  good  anatomical  reasons  why  lesion 
n  the  upper  dorsal  and  cervical  regions  causes  eye  disease.     These  portions  of 


226  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATKY. 

the  spiue  are  particularly  rich  in  nerve  conneclions  with  the  eye.  These  lesions 
act  by  disturbing  blood  nerve,  or  lyiiipaihic-supply  of  the  eye.  The  blood- 
supply  suffers  sometimes  by  direct  inipingenieni,  as  of  vertebrae  upon  the  ver- 
tebral arteries,  or  by  derangement  of  the  vasomotor  control  by  lesion  to  the 
nerves.  The  lymphatics  suffer  by  direct  impingement,  as  by  clavicular  lesioD 
damming  back  the  Ivmpliaiic  drainage  from  the  head.  The  lesion  affecting 
the  eye  does  so  chiefly,  hovTever,  by  distbrbance  of  the  numerous  important 
nerve-connections  met  in  the  upper  do-sal  and  cervical  regions. 

Experience  has  taught  the  Osteopath  that  bony  lesion  in  those  regions 
causes  most  eye-diseases  and  that  its  removal  cures  them. 

The  superior  cervical  ganglion,  well  known  to  suffer  b\'  lesion  of  atlas, 
axis,  or  3d  cervical,  sends  its  ascending  branch  to  join  the  carotid  and  cav- 
ernous plexuses,  thence  to  help  form  a  secondary  plexus  about  the  opthal- 
mic  arteries  and  to  contribute  branches  to  the  minute  plexus  of  the  sympa- 
thetic within  the  eyeball  itself.  Thus  is  established  a  direct  path  of  com- 
munication between  the  upper  cervical  lesion  and  the  eye. 

The  ciliary  ganglion  lies  at  the  back  of  the  01  bit,  between  the  trunk  of 
the  optic  nerve  and  the  external  rectus  muscle.  In  this  situation  it  is  read- 
ily impinged  by  that  treatment  that  presses  the  e)  eball  back  into  the  orbit. 
With  this  ganglion  are  connected  the  3d,  5th  and  sympathetic  nerves,  it 
thus  becoming,  through  the  functions  of  these  neives,  a  sensory  motor,  and 
sympathetic  center  for  the  eye-ball.  Neck  lesion,  as  will  be  shown,  may 
effect  either  or  all  of  these  nerve-connections,  in  this  wa)'  deranging  the 
function  of  the  ganglion  with  regard  to  the  eye. 

The  third  cranial  nerve  inner\ates  all  the  voluntary  muscles  of  the  eye 
except  the  external  rectus  and  the  superior  oblique.  It  is  further  the  nerve 
which  contracts  the  pupil  b}-  supplying  the  sphincter  function  of  the  iris. 
This  function  is  shown  by  the  American  Text-Book  of  Ph}  siology  to  have 
its  center  in  the  superior  cervical  ganglion,  where  it  could  be  affected  in 
lesion  of  the  upper  cervical  region,  causing  disturbance  of  accommodation 
in  the  eye.  Neck  lesions  are  known  to  cause  strabismus  and  diplopia 
(cases  23  and  25),  showing  disturbance  b)-  such  lesion  of  the  function  of  the 
3d  nerve.  (Also  of  the  4th  and  6th  )  The  anatomical  relations  in 
strabismus  caused  by  lesion  at  the  2i  dorsal,  and  diplopia  by  lesion  at  the 
7th  cervical  is  not  well  understood.  The  local  treatment  of  the  ciliary 
ganglion  is  important  in  these  motor  disturbances. 

Fibers  antagonistic  to  the  ciliary  function  of  the  third  nerve,  being  di- 
lators ot  the  pupil,  are  found  rising  in  the  third  ventricle,  whence  they  pass 
through  the  medulla  and  cervical  cord  to  the  anterior  roots  of  upper  dorsal 
nerves  and  to  the  first  thoracic  ganglion  of  the  sympathetic.  From  these 
points  the)-  reach  the  eye  zva  the  cervical  s\mpathetic  cord,  ophthalmic  di- 
vision of  the  fifth,  and  its  nasal  and  long  ciliary  branches. 

These  facts  indicate  the  importance  of  upper  cervical,  general   cervical, 


PRACTICK  AND  APPLIED  THERAPEUTICS  OF   OSTEOPATHY,  227 

and    upper  dorsal    lesion  in  the  causation   of  lack  of  accommodation,    eje- 
strain.  and  similar  troubles. 

The  latter  sympathetic  connection  indicates  the  so  called  cilio-spinal 
center  at  the  4th  cervical  to  4th  dorsal.  Ouain  states  that  these  pupillo- 
dilator  fibers  pass  from  the  1st,  2d,  and  3d  dorsal  nerves,  sometimes  also 
from  the  7th  and  8ih   cervical. 

In  addition  to  the  above,  motor  fibers  to  the  involuntary  muscles  of 
the  orbit  and  eye-lids  pass  from  the  upper  four  or  fiv^e  dorsal  nerves.  Also 
retinal  fibers  leave  the  sympathetic  at  the  superior  cervical  ganglion,  pass 
to  the  Gasserian  g.inglioi  of  the  fifth,  thence  through  its  branches  to  the 
eye.  ItisshoA^n  that,  acting  through  these  fibers,  stimulation  of  the  cervi- 
cal sympathetic  causes  constriction  of  the  retinal  arteries,  while  stimulation 
of  the  thoracic  sympathetic  causes  dilatation  of  them.  These  facts  indicate 
the  importance  of  cervical  and  upper  dorsal  lesion  in  vaso-motor  disturb- 
ances in  the  retina,  as  in  retinitis. 

The  fact  that  many  of  these  sympathetics,  as  pointed  out,  pass  to  the 
eye  via  the  fifth  nerve  shows  the  intimate  relation  between  the  superior 
cervical  ganglion,  the  cervical  and  upper  dorsal  sympathetic,  and  the  fifth 
nerve,  consequently  the  potency  of  cervical  and  upper  dorsal  lesion  to  af- 
fect the  fifth  nerve.  This  nerve  sends  its  sensory  ophthalmic  division  to 
join  with  the  sympathetic  from  the  cavernous  plexus.  It  has  trophic  and 
vaso-motor  fibers  to  the  eyeball  and  its  appendages.  Green  states  that  sec- 
tion of  the  fifth  nerve  is  followed  by  keratitis  and  ulceration.  It  has  charge 
of  the  nutrition  of  the  eye-ball,  supplying  also  the  lachrymal  glands,  con- 
junctiva, skin  of  the  lids  and  adjacent  parts  of  the  face.  ^Nutritive  dis- 
turbances of  the  eyes,  such  as  keratitis,  conjunctivitis,  retinitis,  cataract, 
glaucoma,  pteryguim,  etc.,  must  be  referred  to  lesion  affecting  the  fifth 
nerve.  Likewise  optic-nerve-atrophy,  and  other  effects  due  to  insufficient 
nutrition  would  result  from  lesion  affecting  the  fifth. 

Slips  of  the  inferior  maxillary  articulation  are  thought  to  impinge  fibers 
of  the  fifth  nerve,  (articular  brancnes  from  the  auriculo-temporal  nerve) 
and  to  cause  certain  eye  troubles      (case  33.) 

A  review  of  these  various  connections  shows  that  cervical  and  upper 
dorsal  lesion  may  affect: 

I.     The  superior    cervical  ganglion    and  its  sympathetic  connection   with 
the  local  sympathetic  plexus  of  the  eye-ball. 

2.  The  various  cervical  nerves  and  through  them  the  ganglion  and 
the  other  cervical  sympathetics. 

3.  The  pupillo  constrictor  center  in  the  inferior  cervical  ganglion. 

4.  The  pupillo-dilator  center  in  the  same  ganglion  and  at  the  lower 
cervical  and  upper  three  dorsal  nerves. 

5.  The  motor  fibers  from  the  upper  four  or  five  dorsal  nerves  to  the 
involuntary  muscles  of  orbit  and  eyelids. 

*For  important  functions  o£  the  fifth  nerve  see  "Principles  of  Osteopathy." 


228  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

6.  The  fifth  nerve  by  its  connections  with  the  superior  cervical  gang- 
lion and  cervical  sympathetic. 

7.  Constrictors  of  the  retinal  arteries  in  the  cervical   s\mpathetic. 

8.  Dilators  of  the  same  in  the  thoracia  symp.ithetic,  and 
Both  of  these  at  the  superior  cervical  ginglion 

It  is  noticable  that  all  of  these  eight  connection-;,  except  perhaps  No. 
5,  may  be  reached  at  the  superior  cervical  ganglion.  This  explains  the 
special  importance  of  lesion  to  atlas,  axis  and  3rd  cerxical,  before  pointed 
out  as  most  frequent  in  eye-diseases.  These  upper  cervical  lesions  affect 
this  ganglion.  From  the  variety  of  functions  represented  in  these  various 
fibres  congregated  in  the  superior  cervical  ganglion  we  must  conclude  that 
lesion  of  the  atlas,  axis,  or  third,  etc  ,  affecting  thi?  ganglion,  would  cause 
a  \ariet}'  of  diseases  of  the  eye. 

Lesions  causing  stomach,  kidne)',  and  pelvic  di.seases  m  ly  secondarily 
become  the  cause  of  disturbances  in  the  e\'e.  The  relation  here  is  probably 
entirely  reflex  Perhaps  also  in  these  conditions  alteration  of  blood-pres- 
sure is  a  disturbing  factor. 

It  seems  that  cervical  lesion  causing  obstruction  of  the  tear-duct, as  well 
as  manipulation  upon  the  nose  along  its  course  to  open  it,  affect  the  mucous 
membrane  lining  it  through  the  distribution  of  the  fifth   nerve. 

Clavicular  and  first  rib  lesion,  obstructing  the  lymphatic  drainage  of 
the  eye  by  obstructing  the  flow  from  the  deep  cer\ical  l\mphatics  into  the 
thoracic  or  right  Ixmphatic  duct,  may  affect  the  metaljolism  of  the  eye.  It. 
has  been  thought  that  lesion  affecting  the  female  breast  nia\-  react  upon  the 
eye  reflexly. 

The  Prognosis  in  eye-diseases  is,  generally  speaking,  goo  1.  M. irked 
results,  even  to  cure  of  blindness  of  many  yerrs' standing,  have  been  acquir- 
ed. Very  often  surpri<ingl\'  quick  results  have  been  attained.  An  examina- 
tion of  the  case  reports  at  the  opt.-ning  of  this  chapter  will  show  that  in 
twenty-four  of  the  thirtx-three  various  cases  reported  a  cure  was  affected. 
Quick  results,  either  as  cure  or  benefit,  were  att. lined  in  seventeen  cases 
The  cises  met  by  the  Osteopath  are  frequently  of  long  standing  and  in  bad 
condition.  In  many  cases  these  results  were  gotten  after  specialists  had 
failed.     AH  cases  cannot  be  cured.      Many  are  subjects  for  the  specialist. 

The  Treatmenj"  of  eye-diseases  is  necessarily  almost  entirel)-  upon  the 
neck,  as  it  has  been  shown  that  the  lesions  in  these  cases  occur  here.  The 
removal  of  these  various  lesions  is  already  understood  from  discussions  in 
the  previous  pages.  The  treatment  looks,  in  general,  to  the  establishment 
of  perfect  circulation,  and  the  regulation  of  the  nerve-mechanism.  The 
general  neck  treitment,  as  applied  is  cases  of  insomnii,  headache,  apoplex}-, 
etc.,  q  v.,  given  with  a  specific  object  in  view,  would  be  the  method  em- 
ployed (see  also  Chap.  Ill  and  IV). 

In  many  cases  the  simple  removal  of  lesion  is  the  ouly  treatment  required 
Of.eu  this  treatment,  and  th^  general  neck  treatment  may  be  supplemented  by 


PRACTICE  AMD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  229 

local  treatment  upon  the  eye,  and  about  it,  reaching  its  nerve-mechanism  and 
blood  circulation  diiectly.  (  See  Chap.  V.  A  and  B.)  This  work  includes 
treatment  to  the  fifth  nerve  as  the  one  being  in  charge  of  the  nutrition  and 
circulation  of  the  eye.  This  nerve  is  particularly  regarded  in  all  nutritive  dis- 
eases, such  as  keratitis,  and  in  all  inflammatory,  hyperemic  or  anemic  condi- 
tions, such  as  conjunctivitis,  etc. 

In    conjunctivitis  the  local  irritant,  if  one  be  present,  must    be   removed 
Treatment  should  not  be  made  upon  the  eye  in  these  cases,  but  about  it.     The 
chief  treatment  is  in  the  neck,  especially  upon  the  superior  cervical    ganglion 

In  granular  conjunctivities  the  same  treatment  is  made.  The  granula- 
tions must  be  broken  down.  (Chap.  V.)  After  this  the  correction  of  the 
circulation  by  by  the  cervical  treatment  prevents  their  further  growth. 

In  keratitis  treatment  proceeds  as  in  conjunctivitis.  In  both  conditions 
the  fifth  nerve  must  be  especially  treated. 

The  removal  of  lesion  and  the  correction  of  blood-flow  are  the  essential 
points  in  these  and  all  similar  cases. 

In    pterygium   especial  treatment    is  made  to  cut  off  the    "feeders."    (V 
Chap.  V.)  After    this  operation  they  are  absorbed  by  the  corrected  circulation 
by  means  of  the  neck  work.     In  some  cases  removal  of  neck  lesion  is  followed 
by    absorption  of  the  growth,  as  in    case  15.     Sometimes  light   manipulation 
over  the  closed  lid  aids  the  absorption. 

The  same  remarks  apply  to  pannus. 

In  diplopia,  ptosis,  strabismus  and  other  motor  troubles,  lesion  must  be 
sought  as  the  cause  of  the  muscular  palsy,  tension,  etc.  Treatment  is  applied 
to  the  lesion  and  to  the  affected  nerve.  These  troubles  sometimes  yield  to  the 
correction  of  cervical  lesion  alone.  The  muscles  may  be  treated  direcly  as  in 
VI.  Chap.  V. 

In  cataract  the  treatment  looks  to  the  absorption  of  the  cataract  through 
increased  circulation.  Cervical  treatment,  removal  of  lesion,  and  local  treat- 
ment about  the  eye  and  upon  the  fifth  nerve,  all  as  before  described,  have  suc- 
cessfully accomplished  a  cure  in  these  cases. 

In  the  various  optic  nerve  troubles,  also,  the  treatments  are  used  to  aflfect 
the  nerve  through  its  blood-supply.  Numerous  cases  of  blindness  from  optic- 
nerve-atrophy  have  been  cured  in  this  way.  The  optic  nerve  may  be  stimu- 
lated by  tapping  or  pressure  upon  the  eyeball.  (II,  III,  Chap.  V.)  Retinitis 
likewise  yields  to  this  treatment. 

In  conjugate  deviation,  both  eyes  turning  strongly  to  ons  or   other   side 
the  lesion,  usually  cervical,  affects  the  the  third  and    sixth    nerves,   supplying 
respectively  the  internal  ructus  and  the  external  ructus  of  the  eyeballs.     The 
treatment  is  local  and  cervical. 


230  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 


DISEASES  OF  THE  EAR. 

Cases:  (i)  Deafness  of  two  \ears' duration  in  a  lady  of  foit)-t\vo, 
caused  by  displacement  of  atlas  to  the  rifjht,  tightening  muscles  and  liga- 
ments around  the  ear  and  lower  jaw.  Tenderness  was  extreme  in  the  cervi- 
cial  region.  Dry  catarrh  was  present.  There  was  lesion  of  the  2iid  cervi- 
cal vertebra.  The  patient  had  been  injured  in  a  railroad  wreck,  being 
confined  to  the  bed.  She  could  not  hear  a  clocl;  strike  in  the  room,  nor 
the  playing  of  a  piano.  After  three  treatments  the  patient  could  hear  the 
clock  strike.  After  five  weeks'  treatment  the  hearing  was  complete!)-  re- 
stored. 

(2)  A  case  of  deafness,  pronounced  by  specialists  incurable,  was 
treated  four  weeks  osteopathically  and  again  examined  b)-  a  specialist,  who 
pronounced  the  case  cured. 

(3)  Deafness  in  a  young  bow  due  to  lesion  of  the  atlas.  The  deafness 
was  complete  in  one  ear,  and  almost  so  in  the  other.  After  one  month's 
treatment  he  could  hear  con\'ersation  spoken  in  an  ordinary  tone. 

(4)  Total  deafness  of  several  years'  standing  much  benefitted  by  ihree 
weeks'  treatment,  the  patient  being  able  to  hear  the  street  cars  pass  the 
house. 

(5)  In  a  bo}'  of  fourteen,  a  continuous  discharge  from  the  right  ear, 
of  ten  years'  standing.  Lesion  of  the  atlas  and  axis,  luxated  to  the  right, 
and  contraction  of  the  tissues.     The  case  was  cured  in  nine  treatments. 

(6)  In  a  boy  of  eleven,  partial  deafness  in,  and  continual  discharge 
from  one  ear.  The  lesion  was  a  slip  of  the  atlas.  The  cast^  was  cured  in 
one  month's  treatment. 

(7)  In  a  young  lady,  an  abscess  in  one  ear  had  been  discharging  for 
several  months.  After  one  treatment  there  was  no  further  discharge,  and 
after  four  treatments  the  trouble  had  disappeared. 

The  Lesion  in  ear  diseases,  as  illustrated  b\-  the  above  cases,  are  al- 
most as  a  rule  in  the  atlas  and  axis.  The  3rd  ccr\  ical  and  other  cervicals 
may  be  affected,  but  in  the  vast  majority  of  cases  the  atlas  and  axis,  one 
or  both,  are  affected.  It  is  more  often  at  the  atlas  than  elsewhere.  A 
lu.xation  of  the  temporo-maxillary  articulation,  impinging  probably  the 
articular  fibres  of  the  auriculo-temporal  branch  of  the  inferior-maxillary 
division  of  the  fifth  nerve, and  contractured  tissues  abjat  th;  upper  cervical 
region  and  the  angle  of  the  jaw  may  act  as  lesions  in  tliese  diseases. 

The  fifth  nerve  supplies  the  external  auditory  canal  by  its  auriculo- 
temporal branches,  the  upper  one  of  which  sen  Js  a  branch  to  the  tympanum. 
Also  the  vidian  of  the  fifth  sends  nasal  branches  to  the  membrane  of  the 
end  of  the  Eustachian  tube.  The  internal  throat  treatment  given  to  affect 
this  tube,  does  so  b>'  stimulating  these  fibres,  thus  freeing  the  secretions  in 
this    portion  of  the  Eustachian  tube.     Reasoning  by  analogy,  doubtless  the 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


231 


secretor)',  trophic,  and  \aso-motor  functions  of  the  fifth  ner\'e  with  relation 
to  the  e)e  and  other  parts  of  the  head  and  face  are  extended  to  the  ear 
secretion  of  cerumen  and  circulation  about  the  ear  being  to  some  extent 
under  control  of  the  fifth.  Experience  connects  lesions  of  this  nerve  with 
ear-diseases.  It  has  been  shown  above  that  the  nerve  suffers  from  lesion 
of  the  upper  cervical  region,  such  as  occur  in  ear  troubles  (see  Diseases  of 
the  Eye).  The  treatment  of  this  nerve,  so  important  in  nasal  catarrh  and 
oiher  inflimmatoi  y  affections  of  the  eye,  nose,  and  parts  of  the  head,  is  im- 
portant likewise  in  these  catarrhal,  inflammatory,  and  other  circulatiory 
troubles,  so  commonly  complicated  with  the  diseases  of  the  ear. 

Vdso-constrictor  fibres  for  the  ear  are  contained  in  the  cervical  sympa- 
thetic. They  constitute  another  pathway  for  the  effect  of  cervical  lesion  to 
reach  the  ear.  Likewise  the  atlas  and  axis  lesion  may  affect  the  blood- 
supply  of  the  ear  through  the  medulla,  which  suffers  from  these  lesions.  It 
is  possible  that  vaso-motors  for  the  head  exist  in  the  upper  dorsal  nerves 
though  upper  dorsal  lesion  is  rare  in  ear  trouble.  It  is  likely  that  much  of 
the  effect  of  cervical  lesion  upon  the  ears  is  gotten  through  the  vaso-motors 
and  other  sympathetics. 

The  claim  is  made  that  the  auditor)-  nerve  may  be  inhibited  bv  deep 
pressure  opposite  and  behind  the  third  cervical  vertebra. 

The  pneumogastric  nerve  has  an  auricular  branch,  and  is  in  close  con- 
nection with  the  fifth  in  relation  to  the  ear,  as  well  as  with  the  cervical 
sympathetic.  The  petrosal  ganglion  of  the  glosso-pharyngeal  is  related  to 
upper  cervical  lesion  by  sending  a  branch  to  the  superior  cervical  ganglion. 
Its  tympanic  branch  passes  from  this  ganglion  and  contributes  fibres  to  the 
mucous  lining  of  the  middle  ear,  and  to  the  mastoid  cells.  It  sends  branches 
to  unite  with  the  sympathetic  and  form  a  plexus  on  the  carotid  artery  in 
the  carotid  canal-  Thus  is  this  nerve  connected  both  with  neck  lesions  and 
with  the  blood-supply  to  the  ear.  The  facial  nerve,  well  known  to  be  in- 
fluenced by  lesions  of  the  atlas  and  axis,  as  seen  in  facial  paralysis,  has 
direct  communication  with  the  auditory  nerve  and  with  the  auricular  branch 
of  the  pneumogastric. 

The  various  simple  methods  described  in  the  texts  on  this  subject  will  ai  d 
one  to  determine  the  location  of  the  trouble  in  the  external,  middle  or  in- 
ternal ear.  The  disease  may  be  seated  in  the  auditory  nerve  or  in  the  brain, 
in  such  case  being  as  directly  connected  with  cervical  lesion,  before  shown 
to  affect  the  brain  and  cranial  nerves. 

Treatment:  An  ear  syringe  may  be  used  in  the  ordinary  ways  to 
cleans  the  ear  of  secretions,  discharges,  foreign  objects,  etc. 

The  removal  of  bony  lesion  and  the  cervical  treatment  as  before  describ- 
ed are  the  main  osteopathic  treatments  applied  in  ear  diseases.  The  pre- 
sence of  the  original  cause  of  these  diseases  in  the  form  of  neck  lesion  ne- 
cessitates practically  the  whole  treatments  being  cervical.  There  is  no  iocal 


232  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTKOPATHV. 

ear  treatment,  except  as  in  the  common  methods  in  \ogue  in  use  of  springe, 
etc. 

Outside  of  removal  of  lesion,  an  almost  specific  treatment  for  eye  and 
ear  is  that  of  opening  the  mouth  against  resistance  (Chap.  IV,  Div.  I,  II. 
\'II).andthe  neck  treatment,  with  the  object  of  increasing  circulation 
through  the  carotid  arteries.  Due  attention  is  given  to  the  cervical  sjmpa- 
thetics  and  vaso-motors  in  this  connection. 

The  internal  throat  treatment  (p.  24)  may  be  used,  the  finger  being 
directed  about  the  opening  of  the  Eustachian  tube  to  stimulate  the  local 
points  of  the  fifth  nerve,  the  mucous  membranes,  and  thus  the  secretions. 
This  aids  in  freeing  the  tube,  an  object  that  is  well  accomplished  b\-  the  aid 
of  the  external  throat  treatment  upon  the  carotids,  etc. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  233 


GOITRE 

Cases:  (i)  In  a  lad}-  of  twenty-five,  a  bilateral,  vascular  goitre  of 
about  three  months'  standing,  growing  rapidly,  causing  considerable  dys- 
pnea and  discomfort.  The  treatment  consisted  merely  of  stretching  the 
muscles  and  ligaments  attached  to  the  sternal  end  of  the  clavicle,  raising 
it,  and  depressing  the  first  rib.  Marked  improvement  followed  the  treat- 
ment at  once.  Two  months  later  the  enlargement  and  other  symptoms  had 
disappeared. 

(2)  Exophthalmic  goitre  and  nervous  prostration  of  one  months' 
standing.  The  trouble  followed  nervous  strain  and  over-work.  The  goitre 
was  as  large  as  a  hen's-egg,  and  the  usual  symptoms  of  exophthalmic  goitre 
were  present.  The  case  yielded  rapidly  to  treatment  and  at  the  end  of  two 
weeks  the  goitre  had  disappeared  and  the  eyes  were  normal.  In  one  month 
she  had  recovered  from  the  goitre  and  nervous  prostration,  and  had  gained 
twenty  pounds  in  weight. 

(3)  In  a  boy  of  fourteen,  a  goitre  of  two  >  ears'  standing.  Lesion  ex- 
isted as  a  lowering  of  the  right  clavicle  and  muscular  contracture  in  the 
lower  cervical  and  upper  dorsal  region.  One  treatment  a  week  for  twelve 
weeks  cured  the  case. 

(4)  A  case  of  goitre  treated  by  raising  the  clavicles,  relaxing  the  tis- 
sues surrounding  the  gland,  and  opening  circulation  to  and  from  the  gland. 
After  one  month  there  was  no  perceptible  change;  after  two  months  the 
growth  had  begun  to  get  smaller,  and  after  three  months  the  condition  was 
cured. 

(5)  In  a  lady  of  thirt\-four,  a  large  exophthalmic  goitre  with  all  the 
usual  symptoms  marked  The  general  system  was  in  bad  condition.  Lesion 
was  luxation  of  the  fourth  cervical  vertebra;  the  spine  was  irregular.  The 
case  was  cured  in  six  months. 

(6)  Exophthalmic  goitre  and  eczema  of  the  face  and  neck  in  a  young 
lady  of  twenty-six  cured  in  six  weeks'  treatment. 

(7)  In  a  lady,  a  goitre  of  one  year's  standing.  No  bony  lesions  were 
found.  After  one  month's  treatment  the  diameter  of  the  neck  had  been 
decreased  one  and  one-half  inches. 

Definition: — Goitre  is  defined  as  "a  chronic  hx'pertrophy  or  hyper- 
plasia of  a  portion  or  the  whole  of  the  thyroid  gland.  It  is  of  obscure  ori- 
gin, involving  one  or  more  of  the  structural  tissues,  and  is  subject  to  various 
degenerative  changes." 

This  so  called  simple  goitre  is  met  in  various  forms;  simple  hypertro- 
phic, follicular,  fibrous,  vascular,  cystic,  degenerative,  etc.  They  are  most 
frequenth-  met  and  treated  osteopathically. 

Exophthalmic  goitre  (Grave's  or  Basedow's  disease)  is  quite  a  differ- 
ent condition.     It  is  defined  as,  "a  chronic  neurasthenic  neurosis    character- 


234  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATKY. 

ized  by  rapid  heart-beat,  enlarged  thyroid,  protrusion  of  the  eye  balls,  and 
various  neurasthenic  or  vasomotor  symptoms." 

Osteopathy  simply  regards  goitre  as  an  enlargement  of  the  thyroid 
gland  due  to  a  specific,  usually  bony,  lesion  which  interferes  with  the  proper 
blood  and  lymph  circulation  of  that  body.  This  leads  to  congestion,  en- 
gorgement, and  hypertrophy.  In  some  cases,  especially  in  exophthalmic 
goitre,  the  lesion  may  act  chiefly  upon  the  innervation  of  the  gland,  pro- 
ducing the  various  phenomena  marking  the  disease. 

The  Lesions  bear,  in  conformity  with  the  above  view,  a  close  anatomi- 
cal relation  to  the  disease.  They  are  generally  bony  lesions  of  the  cervi- 
cal and  upper  thoracic  regions,  consisting  in  displacements  of  middle  and 
lower  cervical  vertebrae,  of  the  clavicle,  or  of  the  first  rib.  Yet  various 
muscular,  and  other  tissue,  contractures  are  often  found  as  the  lesions  in  the 
case.  These  commonh-  occur  together  with  bony  lesion,  but  may  be  inde- 
pendent of  such.  The\-  occur  mostly  in  the  anterior  region  of  the  neck,  in- 
volving the  infrahyoid  muscles  and  the  soft  tissues  down  to  the  root  of  the 
neck.  The  scaleni  muscles  are  often  involved.  The  posterior  cervical  and 
upper  dorsal  muscles  are  sometimes  found  contractured  and  acting  as 
lesion. 

The  chief  bony  lesions  in  simple  goitre  are  of  the  clavicle  and  first  rib, 
while  in  exophthalmic  goitre  lesions  of  the  cervical  vertebrae  are  more  fre- 
quent. Vet  either  form  of  lesion  ma\-  occur  in  either  case.  The  clavicle 
and  rib  lesion,  and  the  contracturing  of  the  anterior  cervical  tissues  act 
specifically  b\'  obstructing  arterial,  venous,  and  lymphatic  currents  to  and 
from  the  gland.  The  inferior  thyroid  artery  arises  from  the  thyroid  axis, 
which,  lying  behind  the  clavicle  and  scalenus  anticus  muscle  ma)'  suffer 
pressure  from  them  when  abnormal  in  position.  The  superior  tb)roid  artery 
is  related  to  the  infra-h\oid  muscles,  and  ma\-  suffer  from  their  contracture. 
Hut  the  interferences  of  these  lesions  with  the  lymphatic  and  venous  drain- 
age of  the  gland  are  doubtless  most  potent  in  causing  goitre.  The  l)'m- 
phatics  of  the  gland  are  large  and  numerous,  emptying  upon  the  right  into 
the  lymphatic  duct,  upon  the  left  into  the  thoracic  duct,  both  avenues  of 
lymphatic  drainage,  therefore,  lying  where  derangement  of  clavicle  or  of 
first  rib  may  obstruct  them. 

Just  as  clavicular  and  first  rib  lesion  has  been  known  to  obstruct  lym- 
phatic drainage  of  the  breast  and  result  in  so-called  cancer,  the  same  kind 
of  lesion  ma\'  prevent  lymphatic  drainage  and  cause  goitrous  enlargement 
of  the  thyroid. 

In  a  like  manner  the  venous  return  becomes  abridged.  The  superior 
and  middle  thyroid  veins  are  in  relation  to  the  inferior  hyoid  muscles,  and 
suffer  pressure  from  their  contracture.  They  both  empty  into  the  internal 
jugular  vein  which  ma\'  be  obstructed  by  clavicular  lesion.  The  chief 
venous  flow  is  through  the  three  or  four  large  inferior  thyroid  veins,  and  it 
may  be  impinged   by    clavicular  and  anterior  cervical  lesion.     This  view  of 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHV.  235 

lesion  is  well  supoorted  \)y  the  fact  that  simple  goitres  often  rapidly  disap 
pear  after  treatment,  restoring  cla\'icle  and  first  rib  to  position,  relaxing  an- 
terior cer\ical  tissues,  and  reestablishing  perfect  circulation  of  all  fluids  to 
and  from  the  thyroid.  This  has  been  observed  in  some  cases,  probably  of 
vascular  goitre,  by  Dr.  Still,  in  which  the  facts  strikingl}-  illustrate  the  cor- 
rectness of  the  osteopathic  etiology.  In  these  cases  he  saw,  in  a  few  hours, 
a  great  reduction  in  the  volume  of  the  gland  follow  removal  of  such  ob- 
structions to  the  vessels.  The  gland  seemed  to  have  been  rapiJly  emptied 
and  the  goitre  drained  away  by  the  the  renewed  drainage. 

The  nerve-supply  of  the  th)'roid  gland  is  from  the  middle  and  inferior 
cervical  ganglia  of  the  sympathetic.  Consequently  various  vf-rtebral  lesions 
are  found,  especially  in  exophthalmic  goitre.  Such  lesions  have  been  found 
from  the  2nd  to  the  7th  cervical  vertebra.  In  discussing  diseases  of  the  eye 
and  of  the  heart  the  connections  of  the  cervical  sjmpathetic  mechanism 
with  both  of  these  organs  has  been  pointed  out.  The  lesions  occuring  thus 
to  the  innervation  of  the  thyroid,  cervical  lesions,  are  likewise  closely  re- 
lated anatomically  to  the  innervation  of  eye  and  heart,  accounting  in  part 
for  the  related  disturbance  of  these  organs  in  exophthalmic  goitre. 

This  disease  has  been  regarded  by  medical  writers  as  due  to  disturbed 
innervation  of  the  gland,  or  to  an  affection  of  the  sympathetic  nerves.  It 
has  been  sometimes  thought  that  the  seat  of  the  disease  is  in  the  medulla, 
and  that  the  disturbance  of  the  thyroid  function  causes  the  gland  to  throw 
into  the  blood  substances  that  irritate  the  nerves  and  cause  the  various 
neurasthemic  s\mptoms  accompying  the  condition.  It  is  readily  seen  that 
cervical  lesion  may  disturb  the  innervation  of  the  organ,  set  up  the  smypa- 
thetic  disturbance,  and  derange  the  function  of  the  thyroid.  This  disturb- 
ance of  the  s)'mpathetic  innervation  is  further  evident  in  the  \'ascular  con- 
dition of  the  gland,  its  arteries  being  dilated,  and  in  the  paralysis  of  the 
orbital  vessels,  which  become  distended  with  blood  and  cause  the  exoph- 
thalmos. Dana  explains  all  symptoms  upon  the  theory  of  vaso-motor  and 
cardio-motor  paresis,  a  result  that  may  readily  be  due  to  the  operation  of 
cervical  lesion  upon  the  sympathetic. 

The  Prognosis  is  good  in  all  cases.  It  is  to  be  noted  that  aecording 
to  Anders  the  prognosis  in  goitre  (simple)  is  but  guardedly  favorable  as  to 
life,  but  unfavorable  as  to  cure,  while  but  few  cases  of  exophthalmic  goitre  are 
expected  to  be  cured.  Yet  under  osteopathic  treatment  very  numerous 
cases  of  both  kinds  have  been  cured.  A  cure  is  often  effected,  even  in  long 
standing  cases  which  have  tried  all  the  known  remedies. 

The  prognosis  is  most  favorable  in  \ounger  and  shorter  cases,  and  in 
those  in  which  the  gland  is  soft.  Under  treatment,  signs  of  softening  in  a 
part  of  the  gland  are  indications  of  progress.  In  the  vascular  and  paren- 
chymatous forms  the  progress  is  good.  The  former  promise  the  most  for 
quick  results.  In  the  hard,  fibrous  forms,  and  in  those  in  which  degenera- 
tion of  the  tissues,  or  calcareous  infiltration  has  taken  place,  the  prognosis 
is  not  favorable. 


236  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

Some  cases  of  goitre  yield  quickly;  some  are  very  slow.  From  one  to 
three  months'  treatment  is  usually  necessary. 

The  Treatment  looks  at  once  to  the  removal  ot  lesion,  and  to  the  free 
opening  of  Ismpathtic  and  venous  drainage.  All  the  cervical  muscles  must 
be  relaxed.  This  direction  applies  especially  to  the  deep  anterior  cervical 
and  the  h\oid  muscles,  as  well  as  to  the  tissues  about  the  gland. 

Pressure  is  made  downwards  over  th«  goitre,  out  about  its  edges,  and 
along  the  course  of  the  \eins  draining  it.  All  the  tissues  about  the  root  of 
the  neck  auteriorl)-,  and  about  clavicles  and  first  ribs,  must  be  relaxed.  The 
ribs  and  clavicles  should  be  separated,  elevating  the  latter  and  depressing 
the  former. 

Close  attention  should  be  given  to  all  the  cervical  vertebral  articula- 
tions, seeing  that  they  are  perfectly  adjusted. 

In  exophthalmic  goitre  one  must  look  particular!)-  to  the  cervical  sym- 
pathetics,  toning  them  to  overcome  the  vaso  motor  paresis.  Inhibitory 
cardiac  and  local  eye  treatment  may  be  applied  as  before  directed.  A  mod- 
erate pressure  of  the  eye-ball  back  into  its  orbit  aids  in  emptying  the  blood 
from  the  distended  vessels.  For  a  similar  reason  pressure  upon  the  gland, 
in  exophthal,mic  and  in  vascular  forms  of  goitre,  is  a  good  measure.  In  the 
form-r  kind  one  should  look  well  to  the  constitutional  condition  and  to  that 
of  the  general  nervous  S)stem. 


i 


NEURALGIA. 

Cases:     (i)     Severe  facial  neuralgia  of  two  weeks'   standing,    with    in- 
flammatory eruption  upon  the  affected  side,  the  right,  and    inflammation  of  J£ 
the  right  e\e.     The  usual  treatments  had  been  tried  for  two  weeks  without          3 
avail.     The  lesion  was  a  marked  displacement  of  the  atlas  to  the   left.     It 
was  corrected  and  the  case  cured  ir  one  treatment. 

(2)  Facial  neuralgia  affecting  the  right  side  of  the  face  and  head,  es- 
pecially the  forehead  over  the  right  eye.  The  lesion  was  luxation  of  the 
atlas  to  the  left.     The  case  was  cured  in  one  treatment. 

(3)  Facial  neuralgia  of  two  years'  standing  was  grealty  relieved  by 
one  treatment  and  was  cured  in  six  weeks,  the  patient  gaining  twenty-two 
pounds  during  that  time. 

(4)  Facial  neuralgia  and  pains  between  the  shoulders.  The  lesions 
were  contraction  of  cervical  muscles  and  lateral  luxation  of  the  fourth  and 
fifth  dorsal  vertebrae.     Four  treatments  cured  the  case. 

(5)  Brachial  neuralgia,  involving  the  left  arm  and  the  left  side  as  low 
as  the  fifth  rib.  The  pain  was  intense,  and  the  case  was  of  more  than  one 
years'  standing.  The  arm  was  wasted  and  the  pain  continuous.  Lesions 
were  a  lateral  luxation  of  the  second  dorsal  vertebra,  and  contraction  of  the 
muscles  of  the  whole  upper  spinal  region  as  low  as  the  sixth  dorsal  vertebra, 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  237 

drawing  together  the  upper  five  ribs  on  the  left  side  and  causing  intercostal 
neuralgia  in  this  region.  In  two  weeks  the  pain  was  overcome  and  the  arm 
began  to  develope.     The  case  was  cured. 

(6)  Brachial  neuralgia  of  more  than  one  year's  standing.  The  pain 
affected  the  right  arm  and  rendered  it  almost  useless.  The  lesion  was  of 
the  right  first  rib,  pressing  upon  the  brachial  plexus.  At  the  third  treat- 
ment the  rib  was  set  and  the  pain  ceased. 

(7)  Cervico-brachial  neuralgia  in  the  right  arm,  shoulder,  and  chest, 
due  to  lateral  luxation  of  the  5th  cervical  and  third  dorsal  vertebrae  and 
muscular  contractures  of  the  cervical  and  left  intercostal  muscles.  The 
case  was  practically  cured  in  four  months. 

(8)  Intercostal  neuralgia  of  several  years'  standing,  cured  in  less  than 
one  month. 

(9)  Intercostal  neuralgia  due  to  heavy  lifting,  so  severe  that  the  pa- 
tient was  unable  to  sit  erect  without  great  pain.  Lesion  was  depression  of 
3rd  and  4th  ribs  on  both  sides.  Immediaie  relief  followed  treatment,  and 
the  case  was  cured  in  four  weeks. 

(10)  Intercostal  neuralgia  often  years' standing,  causing  an  intense 
pain  in  the  leftside,  extending  to  the  abdomen.  Lesion  was  a  luxation  of 
the  8th  left  rib,  and  the  case  was  cured  by  replacing  it. 

(11)  Spinal  neuralgia  of  a  number  of  years' standing,  due  to  lesion  of 
the  4th  dorsal  vertebra.     The  case  was  cured  in  two  months. 

(12)  Neuralgia  in  the  head,  of  eight  years'  standing,  lasting  continu- 
ally thirty-six  hours  during  each  menstrual  period.  Lesion  was  at  the 
atlas,  with  muscular  contractions  in  the  lower  dorsal  and  lumbar  region. 
The  case  was  cured  in  one  month. 

(13)  Neuralgia  of  the  stomach  of  three  years'  standing,  the  attacks 
coming  on  after  each  meal.  At  the  time  of  examination  so  serious  had  the 
condition  become  that  the  patient  had  not  taken  solid  food  for  more  than 
two  weeks.  Lesion  was  a  lateral  twist  of  the  spine  between  the  sixth  and 
seventh  dorsal  vertebrae  Improvement  followed  one  treatment,  and  the 
case  was  cured  in  about  one  year. 

(14)  Ulnar  neuralgia,  accompanied  by  swelling  of  the  arm  and  of  the 
ulnar  side  of  forearm,  hand,  and  third  and  fourth  fingers.  The  trouble  was 
of  two  years'  duration,  spinal  lesion  was  found  at  the  origin  of  the  brachial 
plexus,  and  a  contraction  of  the  muscles  in  the  upper  dorsal  region.  After 
four  treatments  there  was  no  further  pain,  and  the  case  was  dismissed  cured 
in  one  month, 

(15)  Neuralgia  in  the  third  finger  of  the  right  hand,  of  several  years' 
standing.  Lesion  was  at  the  third  cervical  vertebra,  which  was  corrected 
in  a  few  treatments,  removing  the  condition. 

(16)  Tic  Douloureux  of  twelve  years' standing.  The  pain  would  oc- 
cur spasmodically  in  the  infra-orbital  terminals  of  the  fifth  nerve,  at  inter- 
vals of  from  three  to  ten  minutes.  Lesion  was  found  in  a  displaced  atlas, 
which  was  corected  in  six  weeks,  curing  tne  case. 


238  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

Definition;  "Neuralgia  is  a  pain  in  the  course  of  a  nerve,  unaccom- 
panied by  structural  charges.  It  is  clue  to  irritation,  direct  or  indirect,  of 
the  nerve."  Often  this  irritation  is  from  pressure  of  a  displaced  bony  part 
or  of  contractured  tissues. 

The  Lesions  found  causing  this  condition  are  usually  bons'.  and  these 
act  by  pressing  directl)'  upon  a  nerve,  or  by  affecting  centers  or  s\'mpathe- 
tic  connections.  In  case  6  above,  the  brachial  neuralgia  was  due  to  direct 
pressure  of  the  first  rib  upon  the  brachial  plexus,  of  nerves.  In  case  I  or  2 
it  is  evident  that  lesion  of  the  atlas  was  too  low  to  affect  the  nerve  involv- 
ed, the  fifth  cranial,  by  direct  pressure.  Here  the  effect  may  have  been 
upon  the  medulla,  thus  affecting  the  center  in  which  certain  roots  of  origin 
of  the  fifth  arise,  but  more  probably  the  effect  was  upon  the  nerve  through 
its  numerous  sympathetic  coimections  in  the  upper  part  of  the  cervical  re- 
gion, as  pointed  out  in  the  discussion  of  the  fifth  nerve  in  diseases  of  the 
eye,  q.  v. 

In  intercostal  neuralgia  the  pressure  is  usually  directly  upon  the  nerve 
by  a  displaced  rib.  but  may  be  due  to  vertebral  lesion. 

The  commonest  bory  lesion  in  neuralgia  is  a  luxated  vertebra,  such  a 
cause  having  been  known  to  produce  neuralgia  in  any  part  of  the  body. 
(See  cases  i,  5,  7,  li,  13.)  It  is  probable  that  in  such  cases  the  vertebra 
brings  direct  pressure  upon  the  nerve  as  it  emerges  from  the    spinal    canal. 

Any  bony  part  in  the  body  in  relation  to  nerves  may  become  displaced 
and  impinge  upon  the  adjacent  nerve,  causing  neuralgia.  Frequently  the 
cause  of  irritation  is  pressure  of  contractured  tissues  upon  the  nerve.  This 
occurs  at  the  foramina  of  exit  of  the  various  branches  of  the  fifth  nerve  up- 
on the  face.  The  tissues  at  and  about  the  foramen  become  congested  or 
contractured,  pressing  upon  the  nerve.  These  contractures  may  occur 
along  the  spine,  as  in  case  4.  Contracture  of  the  intercostal  muscles  may 
draw  the  ribs  together,  irritate  the  nerves  and  cause  the  n.euralgia.  Con- 
tractures are  often  the  direct  irritating  cause  in  cases  of  nenralgia  due  to 
exposure,  tranmatism,  etc. 

The  lesion  may  be  one  causing  a  primary  disease,  as  rheumatism,  gout, 
or  specific  infectious  disease,  allowing  of  the  generation  of  poisons  in  the 
s)'stem,  which  affect  the  nerves  by  circulating  in  the  blood. 

In  Tic  Douloureux  the  lesion  is  usually  at  the  atlas,  but  often  is  found 
among  the  other  upper  cervicil  vertebrae.  Contracture  of  the  cervical 
muscles  and  of  the  tissues  about  the  foramina  are  often  the  causes. 

In  Cervico-occipital  neuralgia  the  lesions  are  usually  among  the 
upper  four  cervical  vertebrae. 

In  Intercostal  neuralgia  occur  lesions  of  vertebrae  at  the  origin  of 
the  nerves  affected,  of  the  ribs,  and  of  the  spinal  and  intercostal  muscles. 

Mastodvnia,  or  neuralgia  of  the  breast,  occuring  generally  in  women, 
is  due  to  similar  lesions  as  intercostal  neuralgia.  Commonly  one  finds  rib 
lesion  in  the  region  affected. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  239 

LuMBO-ABDOMiNAL  neuralgia,  marked  by  pain  in  the  lumbar  region, 
hyphogastiium,  buttocks,  or  genitals,  is  caused  by  lesion  in  the  lower  dorsal 
and  lumbar  spine. 

Cervico-brachial  neuralgia  is  due  to  lesion  of  the  lower  cervical  ver- 
tebrae, of  the  first  rib,  clavicle,  and  of  the  upper  dorsal  vertebrae.  It  may 
be  caused  by  vertebral  lesion  anywhere  from  the  atlas  th  the  sixth  dorsal. 

Neuralgia  in  the  lower  limbs  is  due  to  lumbar,  sacral,  or  innominate 
lesions.  Visceral  ueuraliga,  as  of  stomach  or  intestines,  is  caused  by 
vertebral  lesion  of  the  corresponding  spinal  region.  Coccygodynia  is 
caused  by  displacement  of  the  coccyx. 

The  Prognoses  is  good  in  all  kinds  of  neuralgia.  Cases  of  long  stand- 
ing,often  )'ield  at  once.  A  few  treatments,  or  a  single  treatrnent,  common- 
1)',  at  once  relieve  the  poin.     Permanent  cure  is  usually  accomplished. 

The  Treatment  is  simple.  Often  the  removal  of  lesion  is  at  once  suf- 
ficient to  entirely  cure  the  condition.  The  lesion  should  always  be  re- 
moved as  soon  as  possible.  Likewise  any  causes  of  irritation  must  be  re- 
moved, as  an  ulcerated  tooth,  a  cicatrix,  a  growth  in  the  nose,  etc.  Con- 
stitutional conditions  giving  rise  to  neuralgic  states  must  be  met  according 
to  the  case. 

Relax-^tion  of  all  contractured  tissues  must  be  accomplished.  The 
manipulatiou  is  carried  over  the  course  of  the  affected  nerve,  relaxing  the 
tissues  about  it.  The  pain  of  the  disease  does  not  prevent  this  local  treat- 
ment. Inhibition  of  the  pain  is  accomplished,  not  by  pressure,  but  by  light 
manipulation.  The  main  treatment  is  usually  upon  a  lesion  at  the  origin  of 
the  affected  nerve,  or  in  its  path. 

The  above  method  of  treatment  is  appliecd  to  any  special  variety  of 
the  disease.  Tic  Douloureux  often  j'ields  at  once  to  light  manipulation 
over  the  course  of  the  affected  branches  upon  the  face.     (Chap.  V.  B.) 


RHEUMATISM. 

Cases,  (i)  Inflammatory  rheumatism,  off  and  on,  for  sixteen  years. 
The  effect  was  general,  but  the  body  below  the  waist  was  worse,  hip  and 
lower  limbs  being  very  bad.  Lesion  occured  at  the  4th  lumbar  vertebra. 
The  inflammation  began  to  subside  with  the  first  treatment.  The  patient, 
confined  to  the  bed,  was  able  to  sit  up  in  one  week,  and  was  cured  in  five 
weeks. 

(2)  Inflammatory  rheumatism  of  three  years'  standing,  cured  in  two 
months. 

(3)  Inflammatory  rheumatism  of  one  month's  standing,  the  patient 
being  confined  to  the  bed.  The  hands,  feet,  elbows,  and  knees  were  affect- 
ed and  very  painful.  Under  the  first  treatment  the  pain  and  swelling  were 
much  relieved;  the  second  day  the  patient  was  out  of  bed,  and  in  a  short 
time  he  was  cured. 


240  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

(4)  Rheumatic  fever  of  twelve  weeks'  standing  cured   in  three  weeks. 

(5)  Muscular  rheumatism  of  three  years*  standing  in  a  man  of  seventy. 
The  left  lower  limb  was  affected.     The  case  was  cured  in  three  weeks. 

(6)  Muscular  rheumatism  and  swelling  of  the  lower  limbs  in  a  woman 
of  seventy-four.     The  case  was  cured  in  five  treatments. 

(7)  Muscular  rheumatism,  in  the  form  of  torticollis,  following  malar- 
ial fever.  The  condition  was  of  one  month's  standing.  It  improved  from 
the  first  treatment,  and  was  cured  in  three  weeks. 

(8)  Muscular  rheumatism  in  the  shoulder,  the  patient  having  been  un- 
able to  raise  her  hand  to  her  head  for  seven  months.  The  first  rib  was 
found  party  dislocated  at  its  head.  The  arm  could  be  raised  to  the  head 
after  one  treatment,  and  the  case  was  cured  in  one  month. 

(9)  Acute  articular  rheumatism  in  a  lady  of  eighty-three,  of  three 
months'  standing.  Lesions  occured  in  the  upper  dorsal  and  lumbar  regions 
of  the  spine.  The  hips  and  knees  were  affected.  One  month's  treatment 
had  greatly  improved  the  case. 

(10)  Acute  articular  rheumatism  in  a  lady  of  eighty-two,  who  had  suf- 
fered with  attacks  of  this  disease  most  ot  her  lite.  Both  knees  were  much 
swollen,  and  the  patient  had  been  in  bed  for  two  weeks.  Improvement  fol- 
lowed the  first  treatment,  and  in  ten  days  she  could  get  about  very  well. 
The  case  was  cured  in  several  weeks. 

(11)  Articular  rheumatism  affecting  the  foot,  of  six  years'  standing, 
and  due  to  an  upward  dislocation  of  the  tarsal  end  of  the  first  metatarsal 
bone.     The  case  was  cured  by  reducing  the  d'slocation. 

(12)  Chronic  rheumatism  of  three  years'  standing,  occuring  in  the 
spring  and  fall.  The  whole  body  was  affected.  Three  months'  treatment 
had  greatly  benefited  the  case. 

(13)  Chronic  rheumatism  of  eight  months' standing.  The  patient  was 
unable  to  raise  his  hand  to  his  head  or  to  dress  himself.  After  one  treat- 
ment he  could  do  both,  and  the  case  was  pratically  cured  by  four  treatments. 
Lesions  were  found  at  the  third  cervical  vertebra,  1st  to  4th  dorsal,  and  4th 
lumbar. 

(14)  Lumbago,  in  occasional  attacks,  one  of  which  had  been  brought 
on  b)'  bic)cling.  Lesion  was  found  in  a  lateral  luxation  of  the  4th  lumbar 
vertebra.  The  case  was  relieved  by  one  treatment,  and  was  cured  in  three 
treatments. 

(15)  Lumbago,  brought  on  by  a  muscular  strain,  showed  lesions  at  the 
lumbosacral  and  sacro-iliac  articulations.  The  case  was  cured  in  a  few 
treatments. 

Lesions:  In  the  three  forms;  Acute  Articular  Rheumatism,  or  Rheu 
matic  Fever,  or  Inflammatory  Rheumatism,  Chronic,  or  Chronic  Articular 
Rheumatism,  and  Muscular  Rheumatism,  various  bony  and  muscular  lesions 
are  found. 

In  Rheumatic     Fever    special    bony    lesions    may  be    lacking.     Often 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  24I 

spinal  lesions  affecting  liver  and  kidneys  are  found,  and  muscular  contract- 
ures may  be  present  at  lesion.  Bony  lesions  are  apt  to  occur  at  the  origin 
of  the  nerves  supplying  the  affected  points.  Contractured  tissues  due  to 
climatic  effects  are  common. 

In  Muscular  and  Chronic  Rheumatism  specific  lesion  is  much  more 
definite  than  in  Rheumatic  Fever.  Local  bony  lesions  play  an  important 
part  in  the  production  of  muscular  rheumatism,  as  do  also  muscular  con- 
tractures. Both  ma}'  be  due  to  physical  strains.  Contractures  may  like- 
wise be  due  to  exposure  to  inclement  weather,  etc. 

It  is  common  in  muscular  rheumatism  of  shoulders  and  arms  to  find 
luxation  of  the  lower  cervical  and  upper  dorsal  vertebrae,  one  or  several, 
together  with  contractures  in  the  fibres  of  the  trapezius  muscles  in  these 
regions.  So  in  rheumatism  of  special  muscle  groups  bony  lesion  is  quite 
general!)'  found  at  the  on'gin  of  the  nerves  supplying  them.  This  is  equally 
true  for  chronic  articular  rheumatism.  For  example,  in  these  very  numerous 
cases  in  which  the  joints  of  the  lower  limbs  are  affected,  it  is  almost  the 
rule  to  find  lumbar  or  innominate  lesions  obstructing  the  nerve-supply  to 
the  limbs. 

In  rheumatic  affections  of  special  localities  as,  for  example,  the  wrist, 
ankle,  etc.,  it  is  common  to  find  a  local  bony  part  out  of  place,  as  carpal, 
tarsal,  or  metatarsal  bone.  In  lumbago  there  is  almost  invariably  luxation 
of  lumbar  vertebrae,  irritatingthe  nerve  fibres  supplying  the  muscle-bundles 
of  the  erectors  spine. 

The  contracturing  of  tissues  as  the  result  of  chronic  rheumatism  is 
often  sufficient  to  draw  a  joint  out  of  place,  as  in  case  of  the  hip-joint. 

Lesions  in  rheumatism  act  by  deranging  blood  and  nerve  supply, 
locally  or  generally.  In  inflammatory  rheumatism  the  effect  is  a  constitu- 
tional one,  acting  upon  the  system  through  lesions  which  derange  the 
functions  of  liver  and  kidneys,  also  of  the  central  nervous  system.  Yet  this 
condition  is  often  a  good  deal  like  "catching  cold,"  and  presents,  therefore, 
no  constant  lesion. 

In  the  other  forms  of  rheumatism ,  local  derangement  of  ner\'e  and 
blood-supply  is  the  result  of  the  lesion.  This  lesion  may  be  present  at  the 
exact  locality  of  the  effect,  or  in  the  course  or  at  the  origin  of  the  nerves 
suppl)  ing  the  part.  In  the  case  of  muscular  rheumatism  particularly,  the 
fact  that  the  pathology  is  indefinite,  that  no  structural  changes  occur  in  the 
muscles,  and  that  many  authors  regard  it  as  nuralgia,  well  supports  the  os- 
teopathic theory  that  it  is  due  to  bony  or  muscular  lesions  irritating  the 
nerve-supply  of  the  muscles  affected.  This  effect  is  especially  well  shown 
in  that  form  of  muscular  rheumatism  known  asLumbago,  in  which  vertebral 
ksion,  irritating  the  local  nerve-fibres,  is  regarded  as  the  cause,  osteopathic- 
ally.  As  a  matter  of  fact  one  meets  numerous  cases  diagnosed  as  either 
rheumatism  or  neuralgia,  or  to  which  these  terms  are  applied  interchang- 
ably.     From   an    osteopathic    point    of   view   it  makes  but  little  difference 


242  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTKOPATHV. 

which  \ie\v  of  the  case  is  taken.  The  essential  fact  is  lesion  irritating  ner\e- 
supply,  its  remo\al  being  the  necessary-  therapeutic   measure. 

The  Prognosis,  in  all  forms  of  rheumatism,  is  good.  Even  the  so- 
called  incurable  chronic  rheumatism  is  often  cured.  The  prognosis  is  es- 
pecially good  in  inflammator)-  and  muscular  rheumatism.  In  such  cases 
one  expects  to  give  relief  at  one  treatment.  Quick  cures  are  often  made  in 
them.  In  chronic  cases  the  progress  is  siow  because  of  the  deformity,  the 
deposit  in  the  joint,  and  the  thickening  of  the  local  tissues.  Many  of  these 
cases  are  incurable  but  may  be  benefitted.  Up  to  a  certain  point  the  de- 
posits may  be  absorbed,  the  deformity  overcome,  and  the  joint  be  put  in 
good  condition.  It  is  the  rule,  however,  that  the  enlargement  ordeformit}' 
of  the  joint  cannot  be  much  relieved,  though  the  progress  of  the  disease 
may  be  stajed. 

The  Treatment  of  these  cases  must  be  persistent,  but  not  severe.  In 
inflammator}-  rheumatism  the  extreme  pain,  which  cannot  tolerate  the  slight- 
est jarring  of  the  floor,  or  movement  of  the  bed-clothes,  must  be  considered. 
Vet  it  does  not  prevent  treatment  of  the  case.  Delicacy  of  manipulation 
enables  one  to  soon  overcome  the  patient's  fear  and  to  manipulate  the  joints 
at  will.  The  beneficial  effect  of  this  treatment  becomes  at  once  apparent 
in  reduction  of  the  pain  and  inflammation.  Cases  should  not  be  treated  too 
often  or  too  long  at  a  time. 

In  these  cases,  especially  in  rheumatic  fever,  special  attention  must  be 
given  to  stimulating  the  activities  of  kidneys,  li\er,  digestive  system,  and 
skin,  to  remove  poisons  from  the  system  and  to  improve  the  condition  of 
the  blood.  Often  the  treatment  is  at  first  confined  to  these  parts,  so  ini- 
portant  is  it  to  gain  control  of  their  functions. 

A  general  spinal  treatment  is  necessary  in  rheumatic  fever,  for  consti- 
tutional effects.  A  close  watch  must  be  kept  upon  the  general  health,  and 
lungs  and  heart  must  be  kept  well  stimulated.  Careful  stimulation  of  the 
heart  will  prevent  the  disease  reaching  that  part.  It  is  particularly  neces- 
sary to  provide  against  the  heart  being  affected. 

The  circulation  to  the  joint,  muscle,  or  part  affected,  must  be  kept  free. 
This  is  accomplished  by  work  along  its  vessels,  by  removal  of  bony  lesion 
and  muscular  contracture,  but  especially  by  springing  the  bones  of  the  joint 
so  as  to  separate  them  and  allow  of  free  circulation  of  the  blood  to  the 
membran2s.  It  is  in  this  waj'  that  the  deposits  are  removed  and  the  mem- 
branes restored  to  normal  condition. 

In  acute  inflammation  of  a  joint,  also,  its  blood-supply  must  be  kept 
free  and  itself  be  lightl)'  manipulated,  to  take  down  the  inflammation. 

In  muscular  rheumatism  the  muscles  should  be  stretched  and  manipu- 
lated gently  to  stimulate  the  metabolism  of  the  local  tissues,  aiding  th'-m  to 
throw  off  the  poisonous  substances  supposed  to  collect  in  them. 

In  any  case  the  nerve-supply  of  the  part  must  be  treated  from  its  origin, 
and  the  lesion  be  removed. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 


243 


In  Lumbago  the  affected  muscles  must  be  relaxed,  and  the  lesion  be 
reduced.  It  is  readily  affected.  The  patient  may  sit  upon  a  stool, while  the 
practitioner  stands  in  front  and  passes  his  arms  about  the  body,  clasping 
either  side  of  the  spine  well  down  toward  the  sacrum.  He  now  raises  and 
slightly  rotates  the  trunk,  first  to  one  side,  then  to  the  other,  relaxing  the 
muscles,  separating  the  vertebrae,  and  relaxing  rhe  nerve-fibres  from  im  - 
pingement. 

In  inflammatory  rheumatism  one  should  look  after  the  hyo-fene  of  the 
sick  chamber.  Cold  baths  and  sponging  with  tepid  water  are  allowable  for 
the  fever,  but  are  not  usually  necessary  under  the  osteopathic  treatment 
The  patient  should  be  between  blankets,  which  absorb  the  perspiration  and 
prevent  chill.  The  joint  should  be  well  protected  by  being  wrapped  in 
some  soft,  warm  material,  such  as  cotton.  The  diet  should  be  light  and  nu- 
tritious.    Chronic  cases  should  be  protected  from  toil,  exposure,  etc. 


4.Ujue-^jL^-  V.  ^  ''>—  tr^'  (P^'^r-  "^ ''  ^ ' 


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r 


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O'J^^Jt 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHS.  245 


DIABETES  MELLITUS  AND  DIABETES  INSIPIDUS. 

Cases:  (i)  Diabetes  Mellitus  in  a  man  of  thirty  four.  The  disease 
was  well  established  by  urinal)si3  and  the  characterictic  symptoms.  The 
patient  was  a  great  sufferer  from  pain  in  the  lower  dorsal  and  lumbar  re- 
gions, and  showed  bony  lesions  at  the  1 2th  dorsal,  second  and  fifth  lumbar 
vertebrae.  He  was  discharged  cured  after  eight  months'  treatment,  and 
has  since  passed  the  medical  examination  for  life  insurance,  being  pronounc- 
ed a  good  risk. 

(2)  Diabetes  Mellitus  in  a  3  oung  man  of  nineteen,  who  had  been  given 
up  to  die.  He  was  passing  nine  pints  per  day  of  urine  of  a  sp.  gr.  of  1054. 
In  one  week  it  was  reduced  to  1043,  3""^  four  pints  per  day.  He  gained 
strength  daily,  and  was  practicall)'  cured  at  the  time  of  report. 

(3)  Diabetes  Mellitus  in  a  lady  of  fifty-six.  The  patient  had  lost 
eighty    pounds  in  six  months.,  and  her]symptoms  were  very  marked.     The 

.case  was  expected  to  die.  Lesions  were  found  in  the  upper  cervical  ver- 
tebra, also  of  the  2nd  and  3rd  dorsal,  and  lower  dorsal  and  upper  lumbar 
vertebrae.  The  sp.  gr.  of  the  urine  was  1043,  sugar  4  per  cent,  and  quantity 
from  10  to  18  "^Inis  per  diem.  Improvement  was  continuous  from  the  first, 
and  in  fi\e  months   the  case  was  cured. 

(4)  A  case  of  Diabetes  Mellitus  showed,  under  treatment,  continual 
diminution  of  'the  quantity  of  urine,  and  a  complete  disappearance  of  the 
sugar  in  a  few  weeks.  Some  months  later  the  patient  was  still  in  good 
health. 

(5)  Diabetes  Mellitus  in  a  lad>'  of  fifty-six.  She  passed  about  200 
ounces  of  urine  each  day,  containing  a  large  percentage  of  sugar.  A  de- 
pression of  the  right  ribs  over  the  region  of  the  liver.  The  case  showed 
marked  improvement  under  the  treatment.  In  four  months  the  general 
symptoms  were  much  improved,  and  the  quantity  of  sugar  was  less  than 
half  as  much  as  at  first, 

(6)  Diabetes  Mellitus,  in  which  lesions  were  found  in  the  lower  dorsal 
and  lumbar  region.  Also  in  the  cervical  region  and  at  the  atlas.  Marked 
improvement  took  place  under  treatment,  but  the  treatment  was  discon- 
tinued before  a  cure  was  affected. 

(7)  Diabetes  Mellitus  showing  lesion  in  the  lower  dorsal  and  lumbar 
regions.  The  treatment  was  continued  for  four  months,  and  the  case  was 
completely  cured,  the  patient  passing  a  medical  examination  for  life  in- 
surance. 

(8)  Diabetes  Mellitjs  in  a  girl  of  sixteen.  The  case  was  in  an  advanc- 
ed stage,  shokving  a  large  percentage  of  sugar.  The  case  was  cured  in  five 
months. 

(9)  Diabetes  Mellitus  in  a  man  fift}'one  years  of  age*  Lesion  was  a 
posterior  condition  of  the  spine  from  the  sixth  dorsal  to  the  second  lumbar 


246  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY 

vertebra.  At  the  lime  of  report,  one  month's  treatment  had  been  taken, 
and  improvement  was  made. 

(10)  Diabetes  Mellitus  showing  lesion  in  thecervical  and  lower  dorsal 
regions.  The  urine  contained  two  percent  of  sugar.  Complete  cure  was 
made. 

Lesions  causing  diabetes  are  usually  bony  lesions  along  the  spine  from 
the  middle  dorsal  to  the  lower  lumbar  region.  McConnell  notes  the  fact 
that  in  a  number  of  cases  there  was  a  posterior  swerve  of  the  spine  form  the 
middle  dorsal  to  the  upper  lumbar  region. 

Sacral  lesion  has  been  noted  in  these  cases,  some  showing  a  slip  of  the 
ilium,  some  lesion  of  the  fifth  lumbar.  Cervical  lesion,  chiefly  in  the  upper 
cervical  region  is  sometimes  found  in  diabetes  mellitus.  Sometimes  a  rib 
lesion,  as  in  case  5,  occurs  in  the  region  of  the  liver  or  of  the  splanchnics. 

Lesions  of  the  dorsal  and  upper  lumbar  region  inxolve  the  innervation 
of  these  organs,  derangement  of  which  is  thought  to  be  most  closely  as- 
sociated with  diabetes.  Through  their  effects  upon  the  splanchnics  and 
solar-plexus,  they  derange  the  functions  of  the  liver,  pancreas,  and  intes- 
tines, all  thought  to  be  implicated  in  this  condition.  It  is  well  established 
that  pancreatic  disease  is  usually  closely  associated  with  diabetes,  that  a 
glycolytic  ferment  secreted  by  this  gland  is  necessarj'  to  normal  metabol- 
ism. This  being  disturbed  results  in  sugar  in  the  urine.  Such  a  result  is 
doubtless  affected  by  such  lesions  as  above,  interfering  with  the  innerva- 
tion of  the  organ  by  way  of  the  solar  and  splenic  plexuses. 

It  has  already  been  shown  how  closely  are  such  lesion  associated  with 
derangement  of  the  liver  innervation,  the  glycogenic  function  of  the  organ 
being  disturbed  in  diabetes. 

It  may  be  that  these  lesions  likewise  aid  the  condition  b}'  deranging 
the  activities  of  the  intestinal  villi.  According  to  Pavy's  view  of  diabetes  a 
disturbance  in  the  functions  of  the  cells  of  the  intestinal  villi  is  the  essential 
feature  in  the  causation  of  diabetes.  Lesion  to  the  vaso-motor  innervation 
of  the  portal  vessels,  arising  from  the  5th  to  9th  dorsal  may  have  something 
to  do  with  such  a  disturbance.  Lesion  to  the  upper  region  maj-  aid  this 
effect. 

The  influence  of  the  general  nervous  s)stem  in  diabetes  is  v\ell  known, 
but  not  well  understood.  It  is  shown  that  lesions  to  the  medulla,  cord  and 
sympathetic  system  cause  diabetes.  The  various  spinal  and  cervical  bony 
lesions  dobutless  could  do  the  mischief  resulting  in  diabetes,  as  it  has  been 
shown  frequently  that  these  lesions  may  injure  cord,  medulla,  or  sympathe- 
tic system, as  in  paralysis,  etc.  In  this  connection  one  sees  the  importance 
of  upper  cervical  lesions,  which  may  affect  the  medulla.  Here,  in  the  floor 
of  the  fourth  ventricle,  lies  the  so-called  diabetic  center.  It  is  a  point, 
puncture  at  which  results  in  diabetes.  The  effect  is  doubtless  gotten  through 
the  vagi  nerves,  whose  origin  is  from  this  point.  With  regard  to  this  fact, 
also  to  the  well  known  participation  of  the  vagi  in  liver  functions,  it   seems 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  247 

that  cervical  and  spinal  lesion,  affecting  the  vagi  through  their  sympathetic 
cervical  connections,  or  through  their  connections  with  the  solar  plexus, 
may  in  this  way  produce  a  part  of  the  effect  of  lesion  in  diabetes. 

Prognosis.  Although  diabetes  mellitus  is  a  grave,  and,  by  ordinary 
methods,  an  incurable  disease,  the  outcome  under  osteopathic  treatment  is 
usually  more  encouraging.  A  fair  percentage  of  cures  has  been  shown,  Ihere 
being  no  room  for  doubting  the  facts  in  such  cases.  In  accounts  of  twenty- 
six  cases  gathered  by  Dr.  C.  W.  Proctor,  thirteen  improved  continually 
under  the  treatment;  seven  were  entirely  cured;  others  were  yet  under 
treatment. 

It  may  be  well  said  that  in  such  cases  our  prognosis  for  recovery  is 
fair,  and  for  benefit  is  good. 

The  Treatment  is  mainl)'.  as  far  as  the  specific  treatment  is  concerned, 
upon  that  portion  of  the  spine  most  affected  with  lesion,  namely  along  the 
splanchnic  and  lumbar  regions.  It  is  of  course  necessary  to  remove  the 
lesion  as  soon  as  possible.  Treatment  at  the  above  mentioned  regions  is 
particularly  for  restoring  to  normal  the  functions  of  pancreas,  liver  and 
small  intestine. 

As  the  heart,  kidneys,  lungs  and  spleen  undergo  pathological  changes, 
it  is  necessory  to  give  special  attention  to  their  condition,  according  to 
methods  before  given.  The  skin  and  general  excretory  system  must  be 
stimulated  to  aid  in  excreting  the  sugar  from  the  blood.  The  bowels  must 
be  treated  for  the  constipation  which  is  usually  present. 

A  thorough  general  systemic  treatment  is  given  for  the  purpose  of  af- 
fecting the  various  organs  involved  in  the  disease,  stimulating  and  increas- 
ing the  general  nutrition  of  the  body,  which  is  much  affected,  and  of  up- 
building the  general  nervous  system. 

It  is  necessary  to  give  close  attention  to  the  diet  and  regimen  of  the 
patient.  Carbohydrates  must  be  excluded  from  the  diet  as  thoroughly  as 
passible,  no  sugars  nor  starches  being  allowed  in  any  form.  Meats,  fish, 
poultry, eggs  and  green  vegetables  which  do  not  contain  starch(string-beans, 
lettuce,  water  cress,  spinach,  young  onions,  tomatoes,  olives,  celery,)  are 
allowed.  So,  likewise,  are  milk,  cream,  butter  and  cheese.  The  patient 
should  drink  plenty  of  water,  especially  such  alkaline  mineral  waters  as 
Vichy,  Carlsbad,   etc. 

He  should  take  light  exercise,  but  should  avoid  fatigue,  particularly 
inimical  to  his  weakened  condition.  For  the  same  reason,  while  warm  and 
steam  baths  are  recommended,  they  should  not  be  prolonged  for  fear  of  a 
weakening  effect. 

In  Diabetes  Insipidus  the  lesions  are  usually  found  in  the  lower 
splanchnic  area,  affecting  the  kidneys.  Some  cases  show  lesion  of  the 
superior  cervical  vertebrae.  In  the  latter  case  the  effect  may  be  upon  the 
medulla,  or  upon  the  sympathetic  system.  There  is  a  point  in  the  floor 
of  the  fourth  ventricle,  panccure  at  which  causes  diabetes  insipidus. 


248  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATKY.  / 

A 

These  various  bony  lesions  miy  cause  it  l:)y  affcctintj  the  cord,  since  is 
is  known  that  injuries  to  the  cerebro-spinal  axis  result  in  the  disease. 
Anders  regards  the  condition  as  a  vaso-motor  neurosis,  usually  of  oennal, 
sometimes  of  reflex  origin.  It  is  also  thought  to  be  due  to  a  \aso»motor 
relaxation  of  the  kidneys.  It  is  rcadil)- seen  that  spinal  lesion  to  the  renal 
splanchnic  could  result  .in  this  vaso-motor  neurosis  and  give  rise  to  the 
disease. 

The  Prognosis  is  good  under  osteopathic  treatment,  although  the  C(  n- 
dilion  is  regarded  as  incurable.     A  fair  number  of  cases  are  cured. 

The  Treafment  is  mainly  local  for  the  kidne\s,  b\'  removal  of  lesion 
at  the  splanchnic  areas  and  by  the  various  special  vvaj-s  of  affecting  the 
kidne}s  as  pointed  out  in  considering  diseases  of  the  kidne}S. 

Some  general  treatment  for  the  nervous  sj'stem  may  be  necessary. 


DIPHTHERIA. 

Numerous  cases  have  been  treated  successfull\'  b)-  o  teopathy. 

The  Lesions  usually  found  in  such  cases  are  muscular  and  bony  lesions 
in  the  neck.  Dr.  Still  regards  the  important  cause  a  contraction  of  the  tis- 
sues of  the  throat  and  neck,  including  the  scaleni  muscles,  drawing  the  first 
rib  backward  under  the  clavicle  and  thus  disturbing  its  articulation  with  the 
first  dorsal  vertebra.  These  contractures  about  the  throat  interfere  with 
the  venous  circulation  through  the  pharyngeal  and  internal  jugular  veins. 
fa\oring  a  congested  or  a  catarrhal  condition  of  the  mucous  membranes  of 
the  throat,  and  leading  io  diphtheiia.  It  is  well  known  that  catarrhil  con- 
ditions preispose  to  the  disease. 

Bony  lesions  and  muscular  contractures  in  the  cer\  ical  region  interfere 
with  the  innervation  of  the  muscles  and  mucous  membrane  of  the  throat. 
The  S)  iiipathetic  innervation  is  from  the  superior  cervical  ganglion.  This 
distribution  unites  with  fibres  from  the  pneumogastric,  glosso  phalangeal, 
and  external  larjngeal  nerves,  forming  the  phar>  ngeal  plexus.  Hence 
upper  cervical  lesion  may,  by  affecting  the  superior  cerxical  ganglion,  de- 
range the  sjmpathetic  vaso-motor  suppl\'  of  the  phar)ngeal  mucous  mem- 
branes and  lead  to  the  disease. 

The  Prognosis  is  good       The  case  is  usually  readily  cured. 

In  the  Treatment  the  main  idea  is  to  keep  open  the  circulation  about 
the  throat  and  to  thus  prevent  the  formation  of  the  membrane,  or  to  pre- 
vent its  further  growth.  A  thorough  relaxation  of  the  muscles  and  anterior 
tissues  of  the  neck  must  be  maintained.  The  tissues  at  the  root  of  the  neck, 
and  about  the  clavicle  and  first  rib  must  abso  be  kept  free  and  loose.  The 
clavicle  should  be  raised.  The  first  rib  should  be  pressed  downward  and 
forward,  working  at  its  central  articulation  to  correct  the  position  of  its 
head.     By  the  process  of  these  treatments  the  venous  and  lymphatic  drain- 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  249 

age  from  about  the  throat  is  kept  open.  This  regulates  the  vasomotor  dis- 
turbance of  the  membranes,  tends  to  loosen  the  membrane  already  formed, 
and,  by  preventing  further  exudation,  stops  the  further  growth  of  the  mem- 
brane. 

The  splanchnics,  liver,  kidneys  and  bowels  should  be  treated  twice 
daily,  to  keep  free  the  excretion  of  poisons  from  the  system,  and  to  aid 
nutrition,  to  keep  up  the  strength  of  the  system. 

Cervical  bony  lesion  shoujd  be  removed,  and  treatment  should  be  given 
to  the  vagi, superior  cervical  ganglion,  and  cervical  sympathetics  to  correct 
circulation  and  aid  in  gaining  vaso-motor  control. 

The  internal  throat  treatment  should  be  given  to  aid  in  gaining  the 
same  end.  Proper  precautions  should  be  taken  to  protect  the  finger  so  that 
the  child  may  not  wound  it  with  his  teeth.  The  finger  is  inserted  and  swept 
down  over  soft  and  hard  palate,  fauces  and  tonsils,  to  relieve  the  local  in- 
flammation by  starting  the  circulation. 

In  laryngeal  diphtheria  an  external  treatment  about  the  larynx  and 
down  along  the  trachea  is  good.     (Chap.  Ill,  A.  V.) 

A  general  systemic  treatment  should  be  carefully  given  to  build  up  the 
strength.  The  heart  and  lungs  should  be  kept  carefully  stimulated  to  avoid 
complications  in  them.  The  case  should  be  carefully  looked  after  for  some 
time,  to  strengthen  the  heart  and  to  overcome  the  weakness  of    the    throat. 

The  general  treatment  aids  in  preventing  paralysis,  particularly  apt  to 
occur  about  the  throat,  sometimes  in  other  parts  of  the  body. 

The  patient  should  be  isolated  and  the  usual  antiseptic  pecautions 
should  be  practiced.  The  patient  should  be  kept  upon  a  liquid  diet.  Milk 
ice  cream,  broths,  and  the  like  are  used. 


CROUR 

(Spasmodic  Croup,  Catarrhal  Croup,  or  Laryngismus  Stridulus.) 

Definition:  This  is  a  disease  peculiar  to  children  and  held  to  be  chief- 
ly of  nervous  origin,  but  it  is  often  associated  with  acute  catarrhal  laryngitis. 
It  is  associated  with  paroxysmal  coughing,  difficulty  of  breathing,and  at- 
tacks of  threatened  suffocation. 

Numerous  cases  have  been  successfully  treated  by  Osteopathy. 

The  Lesions  of  greatest  importance  in  croup  involve  contracturing  of 
the  muscles  and  tissues  of  the  throat,  irritating  the  pneumogastric  nerves, 
and  their  recurrent  and  superior  laryngeal  branches.  These  contractures 
likewise  prevent  proper  circulation  to  and  from  the  larynx,  and  favor  the 
catarrhal  condition  in  this  way.  The  irritation  of  the  pneumogastrics  and 
their  branches  is  accountable  for  the  spasmodic  condition  of  the  larynx  dur- 
ing the  paroxysms. 

Dr.  Still  ragards  as  important  sacral  and  lower    spinal    bony    lesions  in 


250  PRACTICE  AND  AIM'LIED  THERAPEUTICS  OF  OSTEOPATHY. 

croup.  He  also  finds  a  contracture  of  the  omohyoid  muscle,  drawing  the 
hyoid  bone  down  and  back  ui)on  the  superior  laryngeal  nerve,  irritating  it, 
and  causing  the  spasm  In  croup,  as  in  other  throat  diseases,  he  finds  that 
the  contracture  of  the  cervical  tissues  and  scaleni  muscles  draws  the  first 
rib  back  under  the  clavicle,  draws  it  upward,  and  deranges  its  articulation 
with  the  first  dorsal  vertebra.  This  condition  is  important  in  shutting  off 
venous  and  1\  mphalic  drainage  from  the  larynx,  and  favors  the  inflamma- 
tion of  the  mucous  membrane. 

\'arious  contractures  of  the  posterior  cervical  muscles,  as  well  a>  those 
bony  lesions  common  in  laryngitis,  as  of  atlas,  axis,  and  3rd  'cervical  verte- 
bra, are  sometimes  present,  acting  to  disturb  sympathetic  innervation,  vagi, 
and  circui  ition. 

One  must,  however,  chiefly  regarti  those  contractures  and  bon\'  lesions 
about  the  throat  and  neck  anteriorly.  Ari!>ing  from  exposure,  cold,  etc., 
they  become  the  chief  cause  of  croup 

The  Prognosis  is  good.  Inrmediate  relief  is  given  by  the  treatment. 
The  spasm,  stridulous  breathing,  and  threatened  suffocation  are  o\  ercome 
at  once  by  the  treatment  during  the  attack. 

The  chief  Treatment  is  to  at  once  relax  all  the  anterior  cervical  tissues, 
to  free  the  circulation  and  to  relieve  the  irritation  to  the  superior  and  re- 
current laryngeal  nerves.  The  treatment  should  begin  well  up  beneath  the 
inferior  maxillary  bone,  being  made  especially  about  the  hyoid  bone  and 
muscles,  and  should  be  carried  down  along  the  throat  and  trachea. 

The  h}'oid  bone  should  be  grasped  and  manipulated  laterally,  forward, 
and  upward,  relaxing  the  omo-h)oid  and  other  muscles.  (Chap  III,  A. 
III.  Chap.  IV,  III.) 

The  process  of  treeing  the  circulation  is  materially  aided  b\-  working 
along  the  course  of  the  carotid  arteries  and  internal  jugular  veins,  raising 
the  clavicle,  and  relaxing  the  surrounding  tissues. 

Treatment  may  be  made  close  along  the  lar\nx  and  trachea,  (Chap. 
Ill,  A.  V).     This  is  helpful  during  the  spasm. 

Inhibition  ma)'  be  made  upon  the  superior  laryngeal  nerve  by  pressure 
immediately  below  and  behind  the  greater  cornua  of  the  hyoid  bone,  and 
upon  the  recurrent  lar\  ngeal  at  the  inner  side  of  the  sterno-mastoid  muscle 
at  the  level  of  the  cricoij  cartilage.  This  is  likewise  useful  during  the 
spasm. 

Anders  notes  the  fact  that  sometimes  the  epiglottis  becomes  wedged 
into  the  rima  glottidis,  and  must  be  helped  out  b>-  the  use  of  the  index  fin- 
ger. 

The  spasm  may  be  lessened  by  manipulation  about  the  region  of  the 
diaphragm,  relaxing  it,  and  by  treatment  of  the  phrenic  nerves  in  the  neck. 
(Chap.  Ill,  A.  VIII.) 

Due  attention  must  be  given  to  the  tissues  and  bony  lesions  of  the 
posterior  cer\  ical  region. 


PRACTICK  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  25I 

All  sources  of  reflex  irritation,  as  intestinal  parasites,  dentition,  indi- 
gestion, etc.,  must  be  looked  after.  The  child  should  not  be  allowed  to 
over-eat  or  drink. 

In  spasmodic  croup  the  attack  is  sometimes  relieved  by  easing  an  over- 
loaded stomach.  Tickling  the  fauces  with  the  finger  will  cause  the  vomit- 
i.ig.  Cold  applications  may  be  used  over  the  throat  and  chest.  A  warm 
bath  is  a  convenient  means  to  employ  to  break  up  a  spasm. 


•  WHOOPING-COUGH. 

(pertussis). 

Definition:  An  acute,  highly  contagious  disease,  occuring  chiefly  in 
children,  and  characterized  by  a  catarrhal  infl.^mmation  of  the  mucous  mem- 
brane of  the  respirator)'  tract,  and  by  a  peculiar  spasmodic  cough  ending  in 
a  whooping  inspiration. 

Its  true,  nature  is  not  known,  but  that  theor)'  that  regards  it  as  a  lesion 
of  the  phrenic,  pneumogastric,  sympathetic,  or  recurrent  laryngeal  nerve, 
or  perhaps  of  the  medulla,  best  accords  with  the  osteopathic  view  of  the 
etiology. 

The  Prognosis  is  good.  The  course  may  be  aborted  if  taken  earl>',  but 
if  the  disease  is  well  started  but  little  more  than  alleviation  can  be  accom- 
plished. The  case  is  safely  carried  through,  and  the  danger  of  complica- 
tions is  minimized. 

The  Lesions  In  whooping-cough,  as  in  croup,  the  contraction  of  the 
omo  hyoid  muscle  drawing  the  hyoid  bone  against  the  pneumogastric  nerve 
is  important,  as  is  also  the  contracturing  of  the  cervical  tissues  drawing  the 
first  rib  back,  and  disturbing  its  central  articulation. 

Cervical  bony  lesions  are  found  at  the  upper,  middle,  and  lower  cervi- 
cal vertebrae,  and  bony  lesions  are  also  found  about  the  first  and  second 
dorsal  vertebrae,  the  first  rib  and  clavicle. 

The  upper  cervical  lesion  affects  sympathetics  and  vagi  in  ways  before 
pointed  out.  The  middle  cervical  lesion  affects  phrenics  and  diaphragm, 
sometimes  important  in  this  condition.  The  contractures  of  throat  tissue?, 
lesion  of  clavicle  and  first  rib  retard  venous  and  lymphatic  drainage,  and 
lead  to  catarrhal  conditions,  well  known  to  be  of  much  importance  in  j)ro- 
ducing  the  condition.  The  mucous  membranes  are  thus  weakened  and  laid 
liable  to  the  action  of  the  specific  infection. 

Lesiors  of  the  upper  dorsal  vertebrae  and  of  the  upper  two  or  three 
ribs  maj'  derange  the  sympathetic  connections  of  the  laryngeal  innervation- 

The  Treatment  is  much  the  same  as  in  croup.  The  prime  point  is  to  free 
Ihe  circulation  about  the  larynx  and  whole  respiratory  tract,  as  there  is  a 
catarrhal  condition  of  the  whole  tract.  This  object  involves  the  relaxation 
of  all  the  anterior  cervical  tissues,  treatment  of  the  h3oid  bone  and  relaxa- 


252  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

tion  of  the  omo-hyoid,  raising  the  clavicle,  etc.  All  bony  lesions  of  the 
cervical,  upper  dorsal,  and  upper  thoracic  region  must  be  overcome,  together 
with  existing  contractures,  in  order  to  remove  all  sources  of  irritation  to  the 
laryngeal  innervation.  The  ways  in  which  these  lesions  act,  and  the  method 
of  their  removal  has  before  been  sufficiently  explained. 

For  the  cough,  treatment  should  be  made  down  along  larynx  and 
trachea,  and  about  the  angle  of  the  jaw. 

Dr.  Still  mentions,  also,  treatment  to  the  phrenic  nerves  and  diaphragm 
to  relieve  the  condition. 

The  lungs  may  be  stimulated,  and  all  the  upper  ribj  be  raised,  to  ease 
respiration.  The  lungs,  heart,  kidneys,  and  general  sjstem  must  be  care- 
fully looked  after  and  thoroughly  treated  to  avoid  the  complications  and 
sequelae  that  ma\-  arise  in  the  form  of  broncho-pneumonia,  pleurisy,  per- 
icarditis, acute  nephritis,  etc. 


INFLUENZA 

(La  Grippe — Epidemic  Catarrhal  Fever.) 

Cases  :  (i)  Four  cases  in  one  family  restored  to  usual  health  within 
a  week. 

(2)  Four  cases  cured  in  four  or  fi\»;  treatments,  no  bad  results  follow- 
ing the  disease. 

(3)  La  Grippe,  attacking  the  throat  and  complicated  with  a  severe 
tonsilitis,  was  cured  by  several  treatments. 

(4)  A  severe  attack  of  la  grippe  cured  in  four  days  by  treatment  di- 
rected to  bowels,  kidneys,  and  splanchnic  nerves. 

(5)  A  list  of  thirty-five  cases,  one  of  which  bad  been  cured  by  one 
Ireacment,  and  the  remaining  cases  cured  by  several  treatments,  none  re- 
quiring over  four. 

(6)  A  report  of  a  number  of  cases  of  la  grippe,  all  with  mared  symp- 
toms. In  every  case  the  patient  was  able  to  be  up  in  from  one  to  three  days 
No  complications  nor  sequelae  arose. 

(7)  A  lady  of  seventy-one  had  been  confined  to  her  bed  for  two 
weeks  with  la  grippe  and  rheumatism.  After  seven  treatments  she  was 
about,  the  la  grippe  being  cured  and  the  rheumatism  much  improved. 

(8)  A  case  of  la  grippe  cured  in  four  treatments. 

Lesions  :  While  no  specific  bony  lesion  has  yet  been  mentioned  as 
occurring  in  Influenza,  there  ia  yet  a  specific  condition  of  lesion  doubtless 
closely  associated  with  the  invasion  of  the  disease  into  the  system.  This 
oondition  is  a  general  contracturing  of  the  spinal  muscles,  most  marked  in 
the  upper  dorsal  and  cervical  regions,  but  affecting  the  whole  spinal  sys- 
tem.    This  may  be  regarded  as  the  specific    lesion    in    Influenza.     Dr.  Stil. 


PRACTICE  AMD  APPLIED  THERAPEUTICS  OF  OSTEOPATHY, 

regards  it  as  shutting  down  upon  the  whole  vascular  and  nerve  systems  of 
the  body,  through  the  constricting  affect  of  these  contractures  upon  the 
spinal  nervous  system  through  its  posterior  distribution.  The  result  is  a 
sluggish  condition  of  all  the  vital  fluids,  lymphatic,  blood,  and  nerve. 

While  it  is  doubtless  true  that  the  bacillus  of  Pfeifer  is  the  infecting 
agent,  it  yet  remains  to  account  for  the  sudden  invasion  of  the  system  by 
this  germ,  since  it  is  known  that  the  germs  of  disease  cannot  attack  healthy 
tissues  and  that  a  body  in  perfect  health  is  immune. 

In  this  connection  it  is  significant  that  debilitated  persons  fall  the  easiest 
victims  to  the  malady.  In  a  majority  of  such  individuals  it  is  doubtless  true 
that  various  osteopathic  lesions  already  exist  and  so  weaken  the  system  in 
one  way  or  another  as  to  lay  it  liable  to  the  invasion  of  the  the  germ. 

Just  so,  the  general  muscular  contracture  found  as  the  characteristic 
lesion  in  la  grippe,  acts  upon  the  vital  forces  of  the  system  to  debilitate 
them  and  lay  the  body  liable  to  invasion.  Tnis  theory  would  appear  en- 
tirely reasonable  in  the  light  of  the  fact  that  Pepper  thinks  it  likely  that  the 
germs  exists  everywhere,  but  depends  upon  certain  extraordinary  atmos- 
pheric or  telluric  conditions  for  occasion  to  break  out  into  virulence.  It  is 
quite  reasonable  to  hold  that  some  special  set  of  circumstances,  it  may  even 
be  these  same  extraordinary  atmospheric  conditions,  results  in  these  spinal 
contractures  which,  occurring  coincidentally  with  the  periods  of  virulence 
of  the  germ,  allow  of  the  invasion  of  the  system. 

La  grippe  is  most  frequent  in  bad  weather,  and  it  may  be  that  then 
exposure  to  cold  may  set  up  these  contractures.  While  it  is  true  that 
the  authorities  hold  the  disease  to  be  entirely  independent  of  climate  and 
season,  it  is  yet  true  that  a  person  may  "catch  cold"  at  any  time  and  place, 
these  contractures  being  well  known  to  result. 

It  is  probable  that  the  presence  of  various  lesions,  bony  and  otherwise, 
in  the  body,  determines  the  disease  to  a  special  part  of  the  system,  result- 
ing in  the  peculiar  manifestation  of  the  disease  which  disguishes  it  as  the 
abdominal  type,  the  cerebral  type,  the  thoracic  type,  etc. 

Probably,  too,  such  lesions  are  responsible  for  the  various  complica- 
tions and  sequelae  which  constitute  so  marked  a  feature  of  the  attack,  as 
affections  of  lungs,  heart  and  nervous  system. 

The  Prognosis  under  osteopathic  treatment  is  particularly  good.  One, 
or  a  few  treatments  being  usually  all  that  are  necessar)'  in  uncomplicated 
cases.  When  the  case  is  taken  in  time  complications  do  not  ensue.  If 
present  they  are  usually  readily  overcome  by  the  treatment.  It  is  a  well 
known  fact  that  the  mortality  is  influenza  is  due  chiefly  to  its  complications, 
consequently  not  the  least  satisfactory  result  of  osteopathic  treatment  is  in 
overcoming  danger  of  these.  The  distressing  sequelae,  especially  affecting 
lungs,  nervous  system,  and  eyes  and  ears,  do  not  occur. 

The  Treatment  indicated  is  a  thorough  general  one,  as  for  a  bad  cold, 
including  particularly  the  complete  relaxation  of  all  the  spinal  tissues,  thus 


254  rRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

restoring  the  equilibrium  of  the  vascular  and  nervous  systems.  This  ob- 
ject accomplished,  a  long  step  toward  recovery  has  been   taken. 

During  this  process  occasion  is  taken  to  strongly  stimulate  heart  and 
lungs,  regulating  circulation,  sweeping  out  congestions,  inducing  perspiia- 
tion  and  lessening  fever,  and  sustaining  these  organs  themselves  against 
the  effects  the  disease  is  likely  to  produce  in  them.  This  treatment  em- 
bodies raising  the  clavicle  and  ribs,  work  over  the  chest  anteriorl)',  stimula- 
tion of  the  vaso-motor  and  accelerator  innervation  in  the  upper  dorsal  re- 
gion, etc.,  all  described  in  considering  the  diseases  of  heart  and  lungs. 

The  liver,  kidneys,  bowels  and  fascia  are  likewise  kept  well  stimulated. 

It  is  well,  especially  in  the  rheumatoid  type,  to  carry  the  relaxing  treat- 
ment over  all  parts  of  the  bod\',  flexing  and  rotating  the  thighs,  working 
about  shoulders,  upper  limbs,  neck,  etc.  This  o\ercomes  the  distressing 
general  aching  and  soreness  in  the  muscles. 

Careful  abdominal  treatment  is  called  for,  particularly  if  the  disease 
shows  a  tendenc}-  to  settle  in  that  region.  Work  upon  the  liver,  bowels, 
solar  and  hypogastric  plexuses,  and  splanchnics  in  the  usual  way  will  meet 
these  requirements. 

The  general  spinal  and  cervical  treatment  both  aids  the  general  affect 
and  pro\"ides  against  affection  of  the  central  nervous  system,  brain,  and 
organs  of  special  sense. 

The  general  health  must  be  carefully  guarded,  the  patient  must  be 
kept  from  exposure,  be  prevented  from  going  uut  too  soon,  and  be  kept 
upon  a  light,  nutritious  diet.  This  should  be  largely  fluid  in  case  the 
patient  confined  any  length  of  time  to  his  bed. 

The  fever,  headache,  pains  in  the  e)e-balls,  and  other  manifestations 
of  the  disease  are  treated  speciall)'  in  the  usual  wa)s. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHS.  255 


SCIATICA. 

Sciatica  is  a  disease  in  which  Osteopathy  has  secured  particularly  bril- 
liant results.  Great  numbers  of  cases  have  been  cured,  many  of  them  hav- 
ing tried  previously  every  known  means  of  treatment. 

The  Prognosis  is  good.  Usually  immediate  relief  is  given  upon  the 
first  treatment.  Often  the  case  is  soon  cured,  though  many  cases  call  for  a 
patient  continuance  of  the  treatment. 

The  Lesions  are  almost  always  of  such  a  nature  as  to  bring  irritation 
upon  the  nerve,  either  by  direct  pressure  upon  the  nerve,  or  upon  certain 
fibres  contributing  to  it.  Derangement  of  its  blood-supply  may  play  a  part 
in  producing  the  condition. 

The  common  lesions  are  bony  ones  along  the  lumbar  and  sacral  regions. 
Lesions  of  the  4th  and  5tb  lumbar  vertebrae,  lesions  of  the  first  and  second 
A     sacral  nerves  by  contracture  of  the  tissues  about  them,  innominate  displace- 
"^     ment,  slipping  of  the  sacro  ilac  joint  and  derangement  of  its  ligaments,  dis- 
'^     placement  of  the  sacrum,  and  derangement  of  the  coccyx,  are  all  important 
forms   of    lesion   producing  sciatica.     These  lesions  impinge  the  fibres  con- 
tributing to  or  connecting  with  the  sacral  plexus.   Some  may  directly  press 
upon  the  nerve. 

A  frequent  cause  of  sciatica  is    contracture   of    the    pyriformis    mnscle 

•    upon    the    trunk    of  the  sciatic  nerve.     The  tissues  about  the  sciatic   notch 

may  be  contractured  and  irritate  it.     It  is  said  that  lesion    along    the    cord, 

anywhere  from  the  2nd  dorsal  down,  may  cause  sciatica.     McConnell   states 

that  downward  displacement  of  the  nth  or  12th  rib  may  cause  it. 

The  Treatment  is  simple.  It  calls  for  the  immediath  removal  of  the 
source  of  pressure  or  irritation  by  correction  of  lesion,  A  general  relaxa- 
tion of  tissues  about  the  nerve  and  about  its  connections  is  done,  due  at- 
tention being  given  to  relaxation  of  ligaments,  as  at  the  sacro-iliac  articula- 
tion. 

This  relaxation  of  the  tissues  should  be  carried  along  the  femoral  ves- 
sels, often  thus  relieving  the  condition  in  an  imi)ortant  manner.  The  tissues 
along  the  course  of  the  nerve,  at  the  sciatic  notch,  at  the  back  of  the  thigh, 
and  behind  the  knee  should  be  relaxed  also.  Strong  internal  circumduc- 
tion is  used  to  relax  the  pyriformis  muscle. 

The  sciatic  nerve  should  be  well  stretched  by  one  of  the  meihods  de- 
scribed.    (VI,  p.  49.) 


MALARIA. 

Malaria  is  a  disease  which,  although  due  to  the  activities  of  a  specific 
germ,  the  Hematozooan  of  Leveran,  yet  presents  marked  bony  lesions, 
which  account  for  the  manifestations  of  the  germ  within  the  system. 


256  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

The  Lesions  are  mostly  in  the  splanchnic  area,  disturbing  the  sym- 
pathetic and  vaso-motor  innervation  of  liver,  spleen  and  kidneys.  Mc- 
Connell  notes  lesion  as  a  marked  lateral  deviation  at  thegth  and  loth  dorsal 
vertebrae,  and  a  resulting  downward  luxation  of  the  lOth  rib,  also  lesion  of 
thegth  to  lith  dorsal  vertebrae  or  in  the  corresponding  ribs. 

Dr.  Still  points  out  lesion  at  the  first  lumbar,  at  the  sacrum,  at  the 
splanchnics,  and  in  the  cervical  region. 

These  various  bony  lesions  must  produce  a  marked  affect  upon  the  sym- 
pathetic system,  resulting  in  vaso-motor  disturbance. 

The  Prognosis  is  good.  Dr.  Still  says  that  he  never  needs  to  give  a 
patient  a  second  treatment.  Usually  a  few  treatments  overcome  the  dif- 
ficulty, and  quick  results  are  often  shown.  Yet  it  often  happens  that  but 
slow  progress  is  made.  Complications,  however,  are  prohibited  by  the 
treatment.     Marked  relief  is  at  once  given  during  the  paroxysm. 

The  Tre.\tment  is  directed  particularly  to  the  splanchnic  area,  and  to 
opening  of  the  abdominal  blood-supply.  By  the  splanchnic  and  abdominal 
treatment  liver,  kidneys,  spleen,  and  bowels  are  kept  in  an  active  state. 
This  is  the  chief  object  of  the  treatment. 

Treatment  is  given  at  any  time,  during  or  between  the  paroxysms. 

The  specific  treatment  employed  by  Dr.  Still  in  cases  of  malaria  is  as 
follows:  With  the  patient  sitting  facing  him,  he  passes  his  arms  beneath 
the  axillae  and  grasps  the  spine  with  both  hands,  one  on  either  side  of  the 
spinous  process,  at  the  fourth  dorsal  vertebra.  He  now  draws  the  patient's 
body  toward  him,  though  not  moving  the  patient  from  his  position  on  the 
chair,  thus  stretching  the  spine  and  bringing  pressure  upon  the  4th  vertebra. 
He  closes  this  manoeuvret  by  twisting  or  rotating  the  trunk  slightly,  first  to 
one  side  and  then  to  the  other,  all  the  time  continuing  the  pressure  at  the 
vertebra.  This  simple  process  is  repeated  at  the  12th  dorsal  for  the  renal 
splanchnic.  In  this  way  the  splanchnics  and  renal  splanchnics  are  stim- 
ulated. 

He  concludes  the  treatment  by  momentaril}-  bringing  pressure  with  his 
thumbs  down  upon  the  femeral  arteries.  The  time  of  this  pressure  is  merely 
long  enough  to  allow  one  heart-beat  to  elapse.  His  idea  is  that  this  mo- 
nlentary  damming  back  of  the  femeral  currents  upon  the  heart  causes  it  to 
give  a  sudden  strong  beat  to  overcome  the  resistance,  rousing  it  to  activity 
and  stimulating  the  system. 

A  general  spinal,  cervical,  and  stimulative  treatment  to  heart  and  lungs 
may  be  given  for  the  chill.  This  overcomes  the  intense  vaso-motor  con- 
striction of  the  surface  of  the  body,  collateral  with  an  inward  congestion, 
and  equalizes  th''  circulation.     The  abdominal  treatment  aids  this  process. 

This  general  treatment  likewise  aids  in  taking  down  the  fever.  The 
more  specific  treatment  may  be  given  as  indicated,  in  the  cervical  region, 
upon  the  chief  vaso-motors,  and  vaso-motor  center  of  the  medulla,  via  the 
superior  cervical  ganglion. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  257 

No  specific  treatment  is  called  for  to  allay  the  sweating,  as  this  is  it- 
self a  relief  to  the  patient's  condition.  The  general  method  of  treatment 
described  may  be  properly  applied  during  this  stage  or  during  the  inter- 
mission. 


TYPHOID  FEVER. 

Cases:  (i)  A  case  taken  in  the  usual  way,  and  presenting  the  usual 
symptoms.  The  fever  was  103°  at  4  p.  m.  when  the  Osteopath  was  called. 
The  next  morning  the  fever  was  below  102°,  rising  that  evening  to  103.5°. 
On  the  succeeding  evening  it  was  again  103.5°,  but  this  was  the  highest 
point  reached,  Thereafter,  instead  of  the  temperature  remaining  about 
104°  for  two  weeks,  as  is  typical,  the  gradual  decent  began  immedeately, 
and  in  two  weeks  the  patient  was  well.  As  early  as  five  days  after  treat- 
ment began  most  of  the  symptoms  had  disappeared.  Fourteen  days  after 
treatment  began  the  evening  temperature  was  normal.  Five  days  later  the 
patient  was  out  upon  the  street. 

(2)  This  case,  when  first  seen,  had  a  pulse  of  102,  a  temperature  of 
105°,  and  all  the  usual  symptoms  marked,  even  deleruim  being  present,  and 
the  stools  and  urine  passing  involuntarily.  He  had  been  ill  with  the  fever 
for  two  weeks.  Gradual  descent  of  the  temperature  began  immediately  up- 
on treatment.  It  became  normal  seventeen  ^days  after  treatment  began. 
The  symptoms  began  to  abate  with  the  fever,  all  but  the  weakness  having 
disappeared  in  twelve  days. 

(3)  A  case  seen  on  the  day  after  it  had  taken  to  bed,  with  a  tempera- 
ture of  101°.  In  two  days  the  symptoms  began  to  abate.  On  the  fourth 
day  the  fever  had  risen  to  104°,  falling,  then  rising  on  the  seventh  day  to 
104°  again.  After  this  there  was  a  gradual  descent,  until  on  the  evening  of 
the  twenty-fifth  day  the  temperature  was  normal.  The  usual  period  of  high 
temperature  had  thus  been  prevented. 

(4)  A  case  of  typho-malarial  fever  which  had  been  ill  fonrteen  daj's 
when  the  Osteopath  was  called.  The  temperature  was  103°.  After  six 
treatments  the  case  was  discharged  cured. 

(5)  Typhoid  Fever  and  Pueumonia,  showing  a  temperature  of  105°, 
having  been  ill  thirteen  days  when  the  Osteopath  was  called.  But  one 
treatment  was  given  in  this  case.     It  recovered  entirely. 

(6)  In  a  girl  of  nine,  who  had  suffered  from  typhoid  fever,  the  linger- 
ing effects  of  the  disease,  suffered  from  five  j-ears  before,  were  very  mark- 
ed. The  difficulty  took  the  form  of  acute  attacks  commencing  with  pain 
in  the  eyes,  followed  by  intense  headache  and  delerium,  and  a  rash  upon 
the  skin.  As  this  rash  disappeared,  swelling  and  pain  in  the  joints  would 
follow.  These  attacks  would  recur  about  every  two  weeks.  The  child  was 
emaciated  and  suffered  from    involuutarv  micturition.     She  had  been  under 


258  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY. 

skilled    medical    care,  and  the  case  had  attracted  such  attention  that  it  was 
discussed  before  a  convention  of  physicians  in  Denver. 

Being  treated  osteopathically  during  an  attack,  she  recovered  this  time 
without  the  usual  swelling  and  rheumatic  symptoms.  After  two  months' 
trtatment  the  case  was  discharged  cured. 

The  only  bony  lesion  was  a  lateral  lu.xation  of  the  third  cervical  ver- 
tebra, but  all  of  the  spinal  muscles  were  intensely  contractured. 

These  few  cases  are  quite  typical  of  the  many  treated. 

Lesions:  Dr.  Still  describes,  as  the  characteristic  "typhoid  spine,"  a 
posterior  prominence  of  the  lower  lumbar  region,  caused  b>-  backward  dis- 
placement of  the  3rd,  4th  and  5th  lumbar  \erthbrae.  He  holds  that  the  re- 
sults produced  by  these  lesions  is  a  paralysis  of  the  lymphatic  supply  of  the 
bowels,  by  pressure  upon  the  spinal  nerves  at  their  exit  from  the  interver- 
tebral foramina.  Thus  is  produced  the  essential  typhoid  condition  of  the 
small  intestine  characteristic  of  the  disease. 

He  notes  also  lesions  along  the  upp;  r  dorsal  region,  at  which  point  he 
makes  treatment  upon  the  lungs,  correcting  the  activities  of  the  1)  mphatic 
system,  thus,  as  he  sa>'s,  makmg  water  to  put  out  the  fire  of  the  fever. 

In  general,  the  lesions  found  in  t)phoid  fever  are  rib,  vertebral,  and 
muscular  lesions  affecting  the  splanchnic  and  lumbar  regions  of  the  spine, 
irritating  spinal  nerves,  and  through  them  disturbing  the  sympathetic,  vaso- 
motor, and  lymphatic  supply  of  the  sniall  intestines. 

As  before  pointed  out  in  detail  (see  diseases  of  stomach  and  intestines), 
these  portions  of  the  spine  suffering  from  lesion  give  origin  to  the  visceral 
nerves  of  the  intestines.  The  vaso-motor  supply  of  the  abdominal  vessels, 
according  to  Quain,  is  from  the  splanchnic  and  lumbar  portion  of  the  cord. 
These  include  the  vaso-motors  of  the  jejUuum  and  ileum,  the  seat  of  ulcera- 
tion in  the  disease. 

Pathologicalls',  the  process  in  the  first  two  stajes  of  tj'phoid,  infiltera- 
tion  and  necrosis  of  the  patches,  is  regarded  as  a  vaso-motor  disturbance. 
The  first  stage  is  an  intense  inflammation,  involving  to  a  greater  or  less  de- 
gree the  whole  mucosa.  The  second  stage  is  the  result  of  an  obstructed 
circulation  to  the  parts  of  the  intestine  involved  In  view  of  these  facts  it 
is  evident  that  sucessful  therapeutic  measures  must  gain  \aso-motor  control. 
It  is  an  indication  to  the  Osteopath  that  he  must  do  spinal  work  upon  the 
vaso-motor  area  suppl)ing  the  bowels,  removing  the  lesion  that  is  obstruct- 
ing the  natural  play  of  forces  necessary  to  health. 

The  Prognosis  is  good,  yet  one  must  not  forget  to  be  upon  his  guard, 
constantly,  against  the  complications  and  intercurrent  maladies  that  so 
often  carry  off  the  typhoid  patient.  Under  osteopathic  treatment,  however, 
complications  and  sequelae  are  quite  prevented.  Indeed,  much'fine  osteo- 
pathic work  has  been  done  upon  paralytic  and  various  other  forms  of  the 
sequelae  following  a  former  attack  of  t\  phoid  fever. 

If  taken  within  a  week  or  ten  da\s  the  course  can  be    usually    aborted 


i'l^ACTTCE  AXB  APPLIED  THEKAPEUTICS  OF  OSTEOPATHS.  259 

-:o  a  marked  degree.  Often  cases  gotten  early  have  had  their  course  term- 
inated within  a  few  days.  Bad  case.s,  taken  under  the  treatment  after  so 
Tate  as  the  fourteenth  day,  commonly  at  once  show   marked    improvement. 

The  characteristic  course  of  the  temperature  is  entirely  changed.  It  is 
usual  to  notice,  no  matter  in  what  stage  the  cas-e  may  be  when  it  comes 
under  the  treatment,  that  the  temperature  begins  at  once  to  gradually  de- 
cline. When  the  case  is  taken  before  the  second  week,  the  usual  period  of 
high  temperature  is  prevented. 

Treatment:  The  main  object  of  the  treatment,  as  pointed  out,  is  to 
gain  vaso-motor  control  of  the  intestinal  blood-supply,  and  to  restore  the 
intestinal  lymphatics  to  normal  activity.  Consequently  the  main  treat- 
ment in  these  cases  is  spinal.  It  must  be  devoted  particularly  to  the  cor- 
rection of  the  malpositions  of  the  3d,  4th  and  5th  lumbar  as  described 
above,  and  to  the  removal  of  any  spinal,  muscular,  rib,  or  vertebral  lesion 
present. 

Most  of  the  treatment  in  these  cases  must  be  done  upon  the  spine, 
leaving  the  abdomen  almost  entirely  free  from  manipulation. 

All  the  spinal  muscles  should  be  relaxed,  this,  with  a  careful  cervical 
treatment,  quieting  the  nervous  system,  and  relieving  the  jerking  of  the 
^ubsxdhis  tendlnuvi.  This  treatment  is  carefully  made  while  the  patient  is 
l\ing  upon  one  side.  The  patient  must  not  be  moved  into  various  posi- 
tions anymore  than  can  be  avoided.   It  is  important  to  avoid  fatiguing  him. 

Lungs  and  heart  should  be  kept  gently  stimulated  by  work  in  the  usual 
place  in  the  upper  dorsal.  This  aids  in  keeping  up  the  patient's  strength 
andjin  preventing  complicating  diseases  of  these  organs.  Treatment  at  the 
renal  splanchnics  should  be  given  to  keep  the  kiduej's  active. 

The  main  treatment  being  along  the  splanchnic  and  lumbar  regions, 
these  portions  of  the  spine  are  treated  by  careful  relaxation  of  all  contrac- 
tures, by  gently  springing  the  spine  for  the  relaxation  of  ligaments  and  for 
the  freedom  of  the  nerves,  and  in  removing  the  bon)'  lesions  mentioned. 

The  correction  of  the  lesion  to  3d,  4th,  and  5th  lumbar  controls  the  di- 
arrhoea.    It  may  be  treated  in  the  usual  wa\'. 

The  spleen  and  liver  are  reached  b}'  spinal  work  at  their  innervation. 

The  abdominal  treatment  is  almost  nil.  Any  manipulation  made  here 
should  be  with  extreme  gentleness  It  is  best  to  confine  this  treatment  to 
the  iliac  regions,  raising  the  intestines  slightly,  with  the  idea  of  straighten- 
ing them  in  the  iliac  fossae.     (IV.  Chap.  VIII.) 

The  fever  is  treated  b}'  work  at  the  superior  cervical  ganglion  in  the 
usual  way,  thus  regulating  the  systemic  circulation  by  affecting  the  general 
vasomotor  center  in  the  medulla.  The  treatment  to  the  heart  and  luno-s 
aids  this  process  by  equalizing  the  circulation,  as  does  also  the  general 
spinal  work  and  the  treatment  given  along  the  spine  for  intestinal  circula- 
tion specifically.  The  heart  beat  should  be  slowed  b\'  inhibition  at  the  2d 
to  5th  dorsal,  on  the  left. 


260  PRACTICE    AND  APPLIED  THERAPEUTICS  OF  OSTEOPATKT. 

In  case  of  rapid  beating  of  the  heart,  persisting  sometimes  for  a  long' 
period,      Dr.  Hildreth  finds  that  correction  of  the  left    5th  rib  gives     relief. 

The  hiccough  is  treated  in  the  usual  way. 

In  case  of  hemorrhage  the  patient  should  be  kept  perfectly  quiet,  have 
no  solid  food,  and  an  ice-bag  should  be  applied  over  the  caecum.  The  foot 
of  the  bed  should  be  elevated.  Inhibition  of  peristalsis  should  be  done  by 
work  from  the  c>th  dorsal  down  along  the  lumbar  region. 

In  case  of  perforation,  hot  applications,  or  the  ice-bag,  are  applied  tO' 
the  abdomen  to  relieve  the  patient. 

The  usual  precautions  should  be  taken  for  the  hygiene  of  the  sick  room, 
the  disinfection  of  the  linen,  the  sterilizing  ot  the  stools,  and  urine  and  gen- 
eral cleanliness. 

The  patient's  bod)',  a  part  at  a  time,  should  be  sponged  with  teprd  water 
daily.     The  Brand  system  of  baths  is  much  used  at  the  present  day. 

In  regard  to  diet  the  usual  observance  of  a  strictl\'  liquid  dret  is  fol- 
lowed. Some  are  using  light,  easil)'  digested  food  the  first  week  or  ten 
days,  until  danger  of  perforation  has  arrived.  The  claim  is  made  that  the 
patient's  strength  is  in  this  wa\-  much  l>etter  preserved.  It  would  be  safe 
for  an  Osteopath  to  carr)'  a  case  through  on  such  a  diet  providing  he  got  it 
early  enough  to  prevent  the  danger  of  perforation. 

After  first  taken  the  patient  should  not  be  allowed  to  get  up  from  his 
bed.     A  bed-pan  and  urinal  should  be  used. 

During  convalescence  the  patient's  condition  should  be  carefully 
watched.  The  return  to  a  hearty  diet  should  be  gradual  in  spite  of  his 
great  appetite.  After  a  liquid  diet  the  semi-solid  food  should  not  be  allowed 
until  the  temperature  has  been  normal  a  week. 


ERYSIPEAS. 

(ST.  ANTHONY'S  FIRE.      "THE  ROSE.") 

Erysipelas  is  a  disease  frequently  treated  and  cured  osteopathically. 
The  Prognosis  is  good. 

The  Lesions  are  various  forms  of  obstruction  to  the  circulation  of  the 
part  affected.  The  lesion  may  be  bon)-,  or  a  contracture  of  muscles  or 
other  tissues.  It  ma}'  directly  press  upon  veins  and  ]\  mphatic  vessels,  pre- 
\enting  the  proper  drainage  of  the  part,  or  it  may  derange  the  vaso-motor 
innervation  and  the  S)mpathetic  innervation  of  the  lymphatics.  For  ex- 
ample a  case  of  erysipelas  in  a  lower  limb  was  cured  by  turning  the  head  of 
the  femur  well  in  the  socket,  and  in  raising  tne  abdominal  viscera  up  from 
the  region  of  the  crural  arch,  where  they  were  pressing  upon  the  blood  ves- 
sels and  preventing  drainage  from  the  limb  through  the  femoral  vein  and 
lymphatics.  By  thus  relaxing  the  tissues  and  removing  direct  impinge- 
ment from  the  vessels,  the  blood  flow  was   restored  and  the  case  was  cured. 


PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY.  26l 

Another  case  in  which  the  eruption  appeared  upon  the  face,  was  cured 
by  springing  the  temporol-maxillary  articulation  with  the  assistance  of 
corks  placed  between  the  molar  teeth,  as  one  would  set  a  dislocated  jaw. 
In  this  way  various  tissues  about  the  jaw  may  have  been  relaxed,  or  impinge- 
ment of  the  fibers  of  the  fifth  nerve  removed,  restoring  circulation. 

The  most  usual  lesions  in  er)-sipelas  are  found  prevent'ng  the  circula- 
tion from  the  head,  as  the  face  is  the  part  most  frequently  attacked.  Lesions 
of  cervical  vertebrae  and  muscles  affect  the  vaso-motors  and  sympathetics 
regulating  the  blood  and  lymphatic  circulation  of  the  face,  and  lead  to  in- 
flammation by  obstructing  these  fluids,  the  specific  germ  being  present  and 
attacking  the  part  thus  rendered  liable  to  its  action.  Clavicle  and  first  rib 
lesion  may  directly  obstruct  the  jugular  veins  and  the  cervical  lymphatics, 
leading  to  same  result. 

McConnell  notes  lesion  of  the  2d,  3d,  4th  and  5th  dorsal  vertebrae,  and 
of  corresponding  ribs  and  surrounding  muscles,  causing  erysipelas  in  the 
face,  by  disturbing  sjmpathetic  innervation. 

The  Treatment  is  simple,  calling  for  removal  of  lesion  and  re-estab- 
lishment of  venous  and  lymphatic  drainage  of  the  affected  part.  This  in- 
volves relaxation  Df  muscles  and  other  tissues,  restoration  of  bony  parts  to 
position,  freeing  of  nerve  connections,  etc.,  as  already  pointed  out,  accord- 
ing to  the  part  affected. 

It  is  not  necessary  to  manipulate  the  inflamed  part. 

As  erysipelas  is  a  dermatitis  the  need  of  gaining  vaso-motor  control  is 
apparent.  The  special  treatment  of  the  neck  to  affect  free  circulation  to 
and  from  the  head  and  face  has  been  sufificiently  discussed  in  the  treatment 
of  diphtheria  and  of  the  eruptive  fevers. 

A  general  spinal  treatment  must  be  given  to  strengthen  the  general 
nervous  system  against  the  various  nervous  complications  and  sequelae  that 
may  arise,  such  as  delerium,  coma,  subsultus  tendinum,  etc.  Bowels  must 
be  kept  free,  and  liver  and  kidneys  kept  active  to  get  rid  of  the  poison  of 
the  disease  which  is  deranging  the  constitutional  condition.  The  kidneys 
must  be  especially  supported  against  albuminuria  and  uremia. 

Among  the  hygienic  measures  and  domestic  remedies  recommended, 
are  isolation  of  the  patient,  drinking  of  plenty  of  cold  water,  cold  spong- 
ings  of  the  part,  or  applications  of  iced  cloths,  and  the  application  of  col- 
lodion over  the  eruption.  Carbolized  vaseline  may  be  used  to  anoint  the 
affected  part. 

The  diet  is  important.  The  patient  should  be  liberally  fed  on  a  light, 
nutritious  diet.  Anders  states  that  liberal  feeding  of  the  patient  is  of 
greater  service  to  the  patient  than  any  of  the  recognized  forms  of  medicinal 
treatment,  and  that  lack  of  attention  to  the  diet  during  the  primary  attack 
tends  to  increase  the  frequency  of  relapse 


262  PRACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHY. 

MEASLES. 

(morbilii,  rubeola  ) 

Ver)-  numerous  cases  have  been  successful!)'  treated. 

The  Prognosis  is  good.  The  danger  of  complications  and  sequelae  is 
minimized,  as  these  cases  recover  quickly  and  thoroughl)-  under  the  treat- 
ment. 

While  it  is  held  that  measles,  once  started,  must  run  its  course,  yet  the 
period  of  convalescence  is  shortened  and  the  child  is  about  earlier  without 
danger  of  complications. 

Lesions:  Dr.  Still  describes  in  this  disease  a  general  congestion  of 
the  lymphatics  and  of  the  superficial  fascia,  insufficient  lymphatic  drainage 
of  the  skin  becoming  evident  as  a  cutaneous  rash.  This  general  congestion 
is  due  to  spinal  muscular  contractures  all  along  the  spine,  irritating  the 
spinal  distribution  of  nerves,  and  through  them  deranging  sympathetic 
vaso-motor  and  lymphatic  nerve-supply. 

This  general  congestion  of  the  spinal  muscles  appears  as  lesion  in 
measles.  The  clavicle  max  be  found  with  its  sternal  end  displaced  back- 
ward against  the  vagus  nerve,  causing  the  cough,  and  aiding  to  cause  the 
catarrhal  condition  of  the  bronchi.  Upper  rib  lesions  may  be  found,  their 
correction  relieving  the  cough.  Weakened  children,  especially  those  pre- 
senting upper  spinal  and  thoracic  rib  lesions,  are  apt  to  become  \ictims  of 
pulmonary  tuberculosis  after  measles.  The  clavicle  and  first  rib  lesion,  as 
well  as  various  cervical  bony  lesions  and  muscular  contractures,  probably 
account  for  complications  and  sequelae  in  e\e,  ear,  nose  and  throat.  These 
effects  come  largely  through  obstructed  lymphatic  drainage  from  the  neck, 
a  fact  well  illustrated  by  the  marked  enlargement  of  the  cervical  1}  mph 
glands  as  a  complication  or  sequel  of  the  disease. 

In  the  Treatment  the  first  step,  especiallx-  if  the  rash  has  not  devel- 
oped, is  a  thorough  stimulation  of  the  cutaneous  system,  including  a  gen- 
eral spinal  treatmennt,  with  particular  attention  to  atlas  ancf  axis,  for  effect 
upon  the  vaso-motor  center  in  the  medulla;  upoii  the  second  dorsal  and  fifth 
lumbar,  cutaneous  centers.  In  tardy  cases  one  such  treatment  suffices  to 
bring  out  the  rash  abundantly,  a  desirable  result,  since  upon  its  appearance 
the  headache  and  fever  disappear,  and  the  patient  feels  better. 

This  treatment  would  include  a  general  relaxation  of  the  spinal  mus- 
cles, correcting  the  Ijmphatic  obstruction. 

An  important  effect  of  the  general  spinal  and  cervical  treatment,  to- 
gether with  some  special  treatment  to  heart  and  lungs,  is  to  correct  the  gen- 
eral circulation,  calling  away  from  all  the  viscera  the  abnormal  amount  of 
blood  retained  in  them  as  a  congestion,  in  this  disease.  For  this  purpose 
these  should  be  added  treatment  of  the  splanchnics,  solar  plexus,  liver,  kid- 
ne)s,  and  abdominal  circulation  general!;'. 


PRACTICE  AKD  APPLIED  THERAFEUIICS  OF  OSTEOPATHY.  263 

The  usual  treatment  of  the  throat,  internal  and  external;  of  the  neck;  of 
-clavicle  and  tirst  rib;  of  the  upper  anterior  chest,  raising  the  ribs,  and  work- 
•ing  in  the  anterior  intercostal  spaces  against  the  costal  cartilages;  and  of 
the  face  and  nose,  should  be  given  to  overcome  the  catarrhal  condition  of 
the  respirator}-  tract,  just  as  a  cold  and  a  bronchitis  are  treated. 

The  lungs  should  be  kept  well  supported  by  the  treatment,  to  avoid  the 
danger  of  bronchitis  and  pneumonia.  Likewise  kidneys,  eye,  ear,  nose,  and 
throat  should  be  guarded  against  effects  in  them. 

The  cough  is  relieved  by  relaxing  the  throat  tissues,  treatm-ent  alono- 
the  larynx  and  trachea,  correction  of  first  rib  and  clavicle,  and  raising  of 
the  upper  ribs. 

The  patient  should  remain  in  bed  until  desquamation  is  well  along, 
should  be  in  a  darkened  room  for  the  sake  of  the  e)""s,  and  should  be  kept 
<upon  a  light  diet  of  milk,  bread.,  light  soups,  etc. 

The  general  spinal  treatment,  and  treatment  of  the  cutaneous  system 
and  centers,  vv'll  aid  in  allaying  the  itching  of  the  skin.  For  this  purpose, 
also,  a  daily  warm  bath  may  be  given. 


RUBELLA. 

(FRENCH  OR  GERMAN  MEASLES.) 


VARICELLA. 

(CHICKENPOX.) 

To  these  conditions  we  may  apply  the  same  general  remarks  concern- 
lesions  and  treatment,  osteopathicall}-,  as  made  in  considering  measles. 

The  very  mild  symptoms  accompan)ing  these  conditions  call  for  but 
little  treatment  aside  from  the  general  constitutional  one,  pointed  out  in  de- 
tail in  measles.     These  points  of  treatment  may  be  applied  as  necessary. 

Due  attention  must  be  given  to  avoid  exposure,  the  dangers  of  compli- 
cation, etc.  In  rubella  the  enlargement  of  the  cervical  !)mphatics  calls  for 
attention  in  the  manner  pointed  out.  The  slight  fever  and  catarrhal  symp- 
toms are  readily  overcome.  In  both  conditions  due  attention  must  be  given 
to  the  cervical  and  general  spinal  treatment,  and  to  the  maintenance  of  the 
activities  of  the  \arious  viscera.  Usuall)'  the  spinal  muscles  are  contract- 
ured,  and  must  be  relaxed.  These  contractures  doubtless  effect  the  general 
lymphatic  system  b)-  wa.y  of  the  spinal  nerves.  For  example,  in  varicella 
the  superficial,  lymph  glands  are  sometimes  visibly  enlarged. 

In  varicella  the  usual  precaution  of  preventing  the  child's  scratching 
off  the  scabs  by  putting  mittens  or  bandages  upon  the  hand  and  wrists,  and 
of  painting  the  scab  over  with  collodion  may  be  observed. 


SCARLET  FEVER. 

(scarlatina.) 
Numerous  cases  have  been  successfully   treated    osteopathically.     The 
Prognosis    is  good,  but    must    be  guarded  in  cases  complicated  with  diph- 


264  PRACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATFTY. 

theria.  The  experience  is  to  bring  these  cases  safely  through  the  attack.. 
free  from  connplications  and  sequelae. 

The  Lesions  are,  in  general,  the  same  as  described  for  the  various- 
acute,  specific  fevers.  Contractured  spinal  and  cervical-  muscles  are  noted. 
One  must  e.xpcct  various  bony  lesions,  accounting  for  the  weakness  of  the 
special  parts  attacked  by  complications  or  sequelae,  as  for  the  kidneys^ 
throat,  and  general  nervous  system  by  the  usual  bony  lesions  found  present 
in  diseases  of  these  parts. 

The  Treatment  proceeds  along  the  lines  already  laid  down.  In  this 
case  there  is  especial  need  of  thorough  constitutional  treatment  on  account  of 
the  multiplicity  of  symptoms  and  the  variety  of  organs  sometimes  affected. 

The  general  spinal  treatment  is  given,  relaxing  muscles,.stimulaling  the 
splanchnics,  etc.  Particular  attention  must  be  given  to  lesions  affecting 
the  kidneys,  and  to  the  thorough  treatment  of  the  innervation  of  them^ 
throughout  the  course  of  the  disease,  for  the  purpose  of  avoiding  the  post- 
scarlatinal nephritis,  so  common  a  complication. 

For  a  like  reason  one  must  give  especial  attention  to  the  treatment  of 
the  throat  to  avoid  diphtheria. 

The  cervical  treatment  must  be  carefully  carried  out.  The  marked  en- 
largement of  the  lymphatic  glands  that  sometimes  occurs  ma)-  be  avoided 
or  controlled  by  the  usual  treatment.  Relaxation  of  all  the  anterior  and 
posterior  muscles  and  tissues,  treatment  along  larynx  and  trachea,  raising 
the  clavicles,  etc.,  must  be  done.  This  treatment  frees  the  l)mphatic  and 
blood-circulation  through  the  neck,  and  keeps  eye,  ear,  and  throat  in  good 
condition. 

The  heart  must  be  kept  well  supported  The  fe\er  is  treated  in  the 
usual  way.  When  tiie  patient's  system  is  kept  well  supplied  with  moisture 
by  allowing  him  a  plentiful  suppl)'  of  cold  water,  daily  treatment  of  the  sub- 
maxillar)' salivary  glands  will  aid  in  keeping  the  mouth  and  lips  moist. 

The  irritation  of  the  skin  may  be  relieved  by  the  treatment  indicated 
for  that  purpose  in  measles.  Daily  tepid  sponging  and  warm  bathing,  as 
well  as  anointing  of  the  skin  with  an  animal  fat  or  with  cocoa  butter,  are 
useful  for  this  purpose. 

The  patient  should  be  isolated,  the  scales  shed  in  desquamation  should 
be  carefully  collected  and  burned,  and  the  room  should  be  disinfected  after 
convalescence.  The  diet  should  be  light.  Plenty  of  milk  and  alkaline 
water  may  be  used. 


TUMORS. 

Cases:  (1)  Ovarian  tumor,  upon  which  operation  was  advised,  cured 
by  two  months'  treatment. 

(2)  Uterine  fibroid  tumor,  the  patient  having  for  si.xteen  jears  suffer- 
ed   intensely    at    period.     Surgeons    were    about  to  operate  upon  the  case, 


PTIACTICE  AND  APPLIED  THERAPEUTICS  OF  OSTEOPATHY,  26$ 

wTien  it  was  decided  to  tr\'  Osteopathy.  After  four  treatments  the  period 
"vas  pissed  without  an)-  discomfort.  After  three  months'  treatment  the 
tumor  had  disappeared. 

(3)  Intestinal  fibroid  tumor.  There  was  a  history  of  constipation,  and 
•colick)'  pains  for  a  number  of  weeks,  constantly  increasing  in  severit\'  and 
-and  frequenc\\  and  leading  finallj'  to  spasms. 

The  abdomen  was  much  distendad  with  fec€s  and  gas;  the  lOth.  iith, 
and  I2th  left  ribs  were  displaced  downward.  The  tumor  could  be  deeply 
palpated  in  the  left  side  of  the  abdomen,  at  the  level  of  the  crest  of  the 
i  1  i  u  m . 

The  colon  was  cleared  with  repeated  enemas  of  water  and  oil.  As  the 
tumor  still  remained  an  operation  was  decided  upon.  But,  before  the  day 
set,  the  tumor  loosened  under  osteopathic  treatment,  and  was  passed  from 
the  rectum.  It  was  in  size  i%  by  i^{  inches.  It  was  examined  by  leading 
physicians  who  pronounced  it  fibroid  tumor. 

{4)  A  tumor  upon  the  back  of  the  neck,  due  to  a  much  enlarged 
sebaceous  gland,  had  been  growing  for  ten  years.  Treatment  was  directed 
to  softening  the  contents  of  the  gland  until  able  to  pass  through  the  duct, 
the  passage  being  facilitated  by  removal  of  the  hair  into  the  follicle  of 
which  the  gland  emptied.  Under  the  treatment  the  tumor  had  been  much 
reduced  at  the  time  of  report. 

(5^  A  case  in  which  an  abdominal  tumor  in  the  region  of  the  stomach, 
and  an  epithelial  cancer  upon  the  nose  were  nearly  removed  by  the  treat- 
ment. 

(6)  A  tumor  of  the  brain,  so  called,  was  a  condition  found  to  be  due 
to  a  displacement  of  the  atlas  and  a  great  contraction  of  the  cervical  mus- 
cles. The  head  was  drawn  backward,  and  giddiness,  insomnia,  and  ocular 
disturbance  were  present.  The  condition  seemed  likely  to  lead  to  insanit}', 
and  leading  ph3'sicians  diagnosed  it  as  tumor  upon  the  brain.  Correction 
of  the  lesions  cured  the  case,  and  the  diagnosis  of  cerebral  tumor  was 
shown  to  be  wrong. 

(7)  An  abdominal  tumor  in  a  lady,  the  waist  measuring  46'.;  inches, 
and  increasing  at  the  rate  of  i  in.  per  week.  Lesion  was  found  at  the  5th 
dorsal,  also  at  the  nth,  and  the  left  ribs  were  luxated.  The  tumor  appeared 
to  be  as  large  as  a  cocoanut.  At  the  end  of  one  months'  treatment  the 
growth  had  been  stopped  and  the  waist  measurement  was  reduced  i  in.;  at 
the  end  of  2  months,  13^  in.,  and  had  reached  nearly  her  normal  size.  The 
treatment  was  continued  for  three  months  longer,  and  the  case  was  dis- 
charged cured. 

(8)  A  tumor  of  the  breast,  about  the  size  of  a  walnut,  very  hard  and 
involving  the  center  and  deep  portion  of  the  gland..  Sharp  pains  radiated 
in  all  directions  from  the  tumor,  but  mostly  toward  the  axillaryregion. 

The  condition  was  found  to  be  an  engorgement  due  to  obstructed 
3)mph   vessels,   with   which  the  gland  is  richly  supplied.     The  lesion  was  a 


266  I'RACTICE  AND  APPLIED  THERAPEUTICS    OF  OSTEOPATHr. 

twiit  of  the  clavicle,  narrowing  the  space  between  the  clavicle  and  first  rib^ 
and  caused  by  using  a  crutch  for  a  lame  leg  upan  the  same  side  as  the  lesion. 
Thus  was  caused  an  obstruction  to  the  lymphatic  drainage  of  the  breast^ 
and  the  growth  resulled.  As  a  preliminary  measure  the  limb  was  cured  and 
the  use  of  the  crutch  was  dispensed  with.  The  cla\icle  was  righted  and  the 
growth  began  to  be  absorbed.     The  case  was  cured  in  seven  weeks. 

(9)  A  case  thought  by  the  ph>sicians  a  cancerous  nodolein  the  breast,. 
and  lor  which  operation  was  advised,  was  cured  by  the  treatment. 

(10)  A  tumor  just  external  to  the  \aginal  orifice,  of  four  month's 
standing.  There  was  a  fluid  contained  in  fhe  tumor,  and  it  varied  in  size,, 
becoming  smaller  after  the  patient  had  remained  in  a  recumbent  position 
for  a  few  days.  There  was  prolapsus  of  the  uterus  and  lesion  among  the 
lumbar  vertebrae.     The  case  was  cured  in  two  mouths. 

(11)  An  ovarian  tumor  in  a  patient,  from  whom,  two  years  previousl), 
the  left  ovary  and  a  tumor  weighing  twenty-five  pounds  had  been  removed. 
A  few  months  later  a  tumor  appeared  upon  the  right  oxary,  and  operation 
was  advised.  After  a  month  and  a  half  of  treatment  the  tun)or  had  disap- 
peared. 

(12)  P'ibroid  tumors  of  the  uterus  in  a  patient  who  had,  four  years 
previousl}',  been  injured  in  the  left  side  by  a  viscious  cow.  The  patient  was 
suffering  from  heart  and  bowel  troubles,  and  female  diseases.  Various 
spinal  lesions  were  found.  By  four  treatments  the  tumors  were  loosened 
and  passed,  there  being  several  of  them,  varying  in  size  from  that  of  a  hen's- 
egg  to  that  of  a  walnut, 

The  Trognosis,  generally  speaking,  to  benefit  or  cure  various  tumors 
by  osteopathic  treatment  is  good.  Numerous  cases  ha\e  been  saved  b\'  this 
means  from  the  surgeon's  knife.  While  man)-  tumors  cannot  be  cured,  the 
treatment  merits  a  trial  in  every  case  before  operation  be  submitted  to. 

The  Lesions  are  various  bony,  muscular,  and  other  obstructions  to 
blood  and  hmph  flow,  or  to  nerve-supply.  Some  lesions  cause  tumorous 
growths  by  direet  irritation  of  the  tissues.  A  frequent  cause  of  ti  m  jrs  is 
found  in  lesion  to  the  lymphatic  drainage  of  a  part,  through  direct  pressure 
upon  its  l\mphatic  vessels  or  b\' constrictor  effect  upon  them  by  lesion  to 
the  vaso-motor  and  sympathetic  ner\e  supph'.  Tumors  of  the  breast  are 
very  often  due  tu  such  a  cause,     (cases  8  and  9). 

The  common  lesions  in  tumor  of  the  breast  are  found  at  the  clavicle, 
first  rib,  among  the  upper  five  or  si.x  ribs,  or  among  the  corresponding  ver- 
tebrae. Abdominal  tumors  are  commonly  caused  by  lower  rib  and 
lower  vertebral  lesions,  uterine  tumors  by  sacral  or  lumbar  lesions,  etc. 

The  simple  Treatment  is  to  remove  lesion,  correct  l)mphatic  and 
blood  drainage,  or  remove  any  source  of  direct  irritation  upon  the  tissues. 
Correcting  anatomical  relations  is  the  main  point,  and  commonly  no  man- 
ipulation directly  upon  the  tumor  is  required,  yet  such  a  measure  is  some- 
times employed  to  soften  a  fatty  tumor  and  aid  in  its  absorption,  or  to 
loosen  a  fibroid  growth,  several  such  having  thus  been  loosened  and  dis- 
charged/)<?r  rrr//^;;/  ox  per  vaginat:t.  One  instance  is  recorded  in  which  ex- 
ternal treatment  upon  the  nose  loosened  and  caused  the  discharge  of  a 
cancer  in  the  upper  nasal  passage. 

It  is  a  point  worthy  of  note  that  in  many  instances  fibroids,  according  to 
all  evidences,  have  been  absorbed  by  the  renewed  blood  currents.  It  indi- 
cates that  new  fibrous  tissues,  once  formed,  ma}-  be  absorbed  under  the 
treatment. 


1XU>KX. 


Abdomen,  examination 

treatment 

Angina  Pectoris 

definitions 

Lesions 

prognosis 

treatment 

Ankle,  dislocation 

Appendicitis.       

recurring 

treatment 

Ascites   

prognosis 

treatment 

Asthma 

Atlas 1 

B 

Brachial  Plexus 

Bright's  Disease,  see  Nephritis 

Bronchitis 

C 

Carpal  Dislocations 

Cataract,  treatment 

Cholera  Morbus 

Chorea 

Clavicle,  displacements 

treatment 

Cirrhosis  of  the  Liver 

Coccyx,  treatment 

Colds,  see  Cory za 

Colic 

Congestion  of  the  Lungs 

Constipation  

Coryza 

Croup  

Cystitis 

D 
Diabetes  Insipidus 

"      Mellitus 

Diaphragm 

Diarrhoea,  nervous 

Dilatation  of  the  Heart » 

Diphtheria 

Diseases  of  the  Ear 

"      Eye 

"  "      Heart  and  Circulation. 

•'  *'      Intestine 

Diseases  of  the  Liver. . .    

"  "      Nervous  System 

"  "      Urinary  System 

Dislocations  of 

Ankle  

Carpus 


35 

35 
170 
170 
170 
171 
175 

50 
105 
105 
106 
131 
132 
132 

55 
:,20 

16 


59 


47 

229 

115 

179 

26 

34 

126 

12 

114 


67 
249 
149 

245 
245 
96 
114 
175 
248 
230 
221 
152 
105 
133 
179 
137 

50 
47 


elbow 48 

hip 50 

knee 50 

metacarpo  phalangeal 47 

radio  ulnar 47 

shoulder 48 

E 

Endocarditis 171 

Enteralgia 114 

Enteritis,  catarrhal ifS 

Enteropasm* 115 

Enteroptosis 110 

Enuresis 150 

Epilepsy 181 

Epistaxis 69 

Erysipelas 260 

Eye,  conjunctiva 22 

diseases  of 221 

granulations 22 

pterygia , 22 

strabismus 23 

tapping 23 

F 

Fecal  Impaction 107 

Fifth  nerve,  branches 23 

Fifth  Lumbar  Displacement 11 

G 

Gallstones 128 

Gastralgia 85 

Gastritis,  acute  and  chronic 82 

Glossopharyngeal  nerve 20 

Goitre , , 235 

H 

Hay  Fever 61 

Head,  examination  and  treatment....  22 

Heart  and  Circulatory  Diseases...      .  152 

Hemorrhoids 116 

Hepatic  abscess 133 

Hip,  dislocations 50 

Hyoid  Bone  and  Muscles 15,  19 

Hypertrophy  of  the  Heart 174 

Liver 133 

Hypogastric  Plexus 44 

Hysteria 197 

I 

Influenza.   ....       252 

Ilio  Caecal  Impaction 108 

Innominate  Lesions 41 ,  42,  43 

Insanity 216 

Insomnia 198 

Intussusception 108 

Intestinal  Neuralgia 114 

Intestinal  Obstruction 107 

Intestinal  Tumors 119 


IXJ3KX. 


Jaundice     124 


K 


Keratitis,  treatment. 
Kidney  congestion. . . 

movable 

Knee  Dislocations  . . 


La  Grippe,  see  Influenza 

Laryngitis 

Limbs,  examination  and  treatment. 

Liver,  congestion 

T^ocoraotor  Ataxia  

r^umbago  

M 

Malaria 

Measles 

Membranous  Enteritis 

Metacarpal  Dislocations 

Middle  Cervical  Ganglion 

Migraine 

Mucus  Colitis 

Mumps,  see  Parotitis 

Myelitis 

Myocarditis 

N 
Neck,  examination 

lesions 

treatment 

Nephritis,  acute 

Neuralgia 

Neurasthenia 

Neurosis  of  the  Intestine 

diminished  sensibility 

Motor , 

secretory 

sensorv 


O 
Occupation  neurosis 

P 

I  "aralysis 

Paralysis  Agitans 

Palpitation 

I'arotitis 

Pelvis,  examination  and  treatment... 

Pelvic  Plexus 

Pericarditis 

Peritonitis 

Pertussis,  see  Whooping  Cough 

l^hrenic  nerve J  6,  20 

Piles,  see  Hemorrhoids 

Pleurisy 


229 

144 

148 

50 


79 

47 

126 

189 

240 

255 
262 
113 
47 
18 
184 
113 

214 
171 

15 
16 
19 
142 
236 
195 
113 
114 
114 
113 
114 

192 

205 

191 

166 

82 

38 

44 

164 

121 


70 


Pneumogastric  nerve 16,  20 

Pneumonia 64 

Pterygium,  treatment 229 

Pulmonary  consumption 75 

Pyelitis 148 

R 

Radio  Ulnar  Dislocation 47 

Rectal  treatment 13,44 

Renal  Calculi 147 

Rheumatism 2.39 

Rib  Luxations 26 

Rib  treatments .     31 

Rubella 263 

S 

Sacrum  displacements 12 

Scarlet  Fever 263 

Sjiatica 255 

Shoulder  dislocation ...    47 

Spastic  Paraplegia 189 

Spinal  Accessory  Nerve 20 

Spinal  Meningitis 214 

Spine  examination 5 

lesion *     6 

treatment 8 

Spleen      131 

Splenic  Hyperaemia 1.35 

Splenitis 134 

Sternum  di placements 26 

Stomach  diseases 85 

Superior  Cervical  Ganglion.   . .    18 

T 
Thorax,  examination  and  treatment..     26 

Tonsillitis 80 

Tonsil 15 

Tuberculosis,  see  P.  Consumption 

Tumors    264 

Typhoid  Fever 257 

U. 

Ulceration  of  the  Stomach 85 

Urinary  System  Diseases 137 

V 

Vagina,  examination  and  treatment  ...115 

Valvular  Diseases 173 

Varicella 263 

Volvulus 107 

Whooping  Cough ...  251 


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PRINTED    IN    U.S.A.                        CAT        NO        24       161                            ^ 

UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


D     000  224  676     7 


WB9U0 

Hli31p 

1900 
Hazzard,  Charles 

Practice  and  applied  therapeutics  c 
osteoj  athy 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

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